Pain is a major matter for patients with multiple sclerosis; treatment response is frequently inadequate, with a significant impact on quality of life. The estimated prevalence of pain in multiple sclerosis ranges widely (26–86%), and different subtypes of pain, mediated by specific pathophysiological mechanisms, are described. The aim of this narrative review, performed using a systematic search methodology, was to provide current, evidence-based, knowledge about the pharmacological treatment of the different kinds of pain in multiple sclerosis. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Clinical Trials database (ClinicalTrials.gov), considering publications up to November 2019. Two authors independently selected studies for inclusion, data extraction, and bias assessment. A total of 27 randomized controlled trials were identified, but in only a few cases, patients with different pain qualities were stratified. Following a mechanism-based approach, treatment of paroxysmal pain and painful tonic spasms should be based on sodium-channel blockers, whereas treatment of ongoing extremity pain should be based on gabapentinoids and antidepressants.

对于多发性硬化症患者来说，疼痛是一个大问题；治疗反应往往不足，对生活质量产生重大影响。多发性硬化症中疼痛的估计患病率范围很广（26-86%），并且描述了由特定病理生理机制介导的不同亚型疼痛。该叙述性综述的目的是使用系统搜索方法进行，目的是提供有关多发性硬化症不同类型疼痛的药物治疗的当前循证知识。我们在 PubMed、EMBASE、Cochrane 系统评价数据库和临床试验数据库 (ClinicalTrials.gov) 中搜索相关论文，考虑到 2019 年 11 月的出版物。两位作者独立选择了纳入、数据提取和偏倚评估的研究。共确定了 27 项随机对照试验，但仅在少数情况下，对不同疼痛性质的患者进行了分层。遵循基于机制的方法，阵发性疼痛和痛性强直性痉挛的治疗应基于钠通道阻滞剂，而持续性肢体疼痛的治疗应基于加巴喷丁和抗抑郁药。