A voxel-based lesion symptom mapping analysis of chronic pain in multiple sclerosis
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ORIGINAL ARTICLE
A voxel-based lesion symptom mapping analysis of chronic pain in multiple sclerosis Domenico Plantone 1 & Catello Vollono 2 & Matteo Pardini 3 & Guido Primiano 2 & Virxhina Myftari 4 & Francesca Vitetta 5 & Patrizia Sola 5 & Massimiliano Mirabella 2 & Diana Ferraro 4,5 Received: 27 December 2019 / Accepted: 19 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Pain is one of the most disabling symptoms in multiple sclerosis. Chronic pain in multiple sclerosis is often neuropathic in nature, although a clear-cut distinction with nociceptive pain is not easy. Objective The aim of our study was to analyze the MRIs of multiple sclerosis patients with chronic pain in order to explore possible associations with lesion sites, on a voxel-by-voxel basis. Materials and methods We enrolled patients aged > 18 years with multiple sclerosis in accordance with the 2010 McDonald criteria. Patients meeting criteria for persistent pain (frequent or constant pain lasting > 3 months) were included in the “pain group”. The other patients were included in the “no pain group”. We outlined lesions on FLAIR MRI scans using a semi-automated edge finding tool. To detect the association between lesion localization and persistent pain, images were analysed with the voxel-based lesion symptom mapping methods implemented in the (nonparametric mapping software included into the MRIcron. Results We enrolled 208 MS patients (140 F, mean age 55.2 ± 9.4 years; 176 RR, 28 progressive MS; mean EDSS 2.0 + 2.0). Pain group included 96 patients and no pain group 112 patients. Lesions of the right dorsolateral prefrontal area were significantly more prevalent in patients without pain, whereas periventricular posterior lesions were significantly more prevalent in patients with persistent pain. Conclusion Our data suggest a role of the right dorsolateral prefrontal cortex in the modulation of pain perception and in the occurrence of chronic pain in MS patients. Our data also support a hemispheric asymmetry in pain perception and modulation. Keywords Multiple sclerosis . Pain . Neuropathic pain
Introduction People with multiple sclerosis (MS) often complain of pain that should be considered as one of the most disabling clinical * Domenico Plantone [email protected] 1
Neurology Unit, Di Venere Hospital–ASL Bari, Via Ospedale Di Venere, 1, 70131 Bari, Italy
2
Neurology Institute, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
3
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
4
Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
5
Neurology Unit, Ospedale Civile, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
symptoms [1–3]. On the basis of the pathophysiology, pain can be nociceptive or neuropathic [4]. Tissue damage activates mechanical, chemical and thermal stimuli that trigger noc
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