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Pharmacotherapeutic Options for Managing Pain in Multiple Sclerosis

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Abstract

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.

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All data generated or analyzed during this study are included in this published article (and its supplementary information files).

References

  1. Nurmikko TJ, Gupta S, Maclver K. Multiple sclerosis related central pain disorders. Curr Pain Headache Rep. 2010;14:189–95.

    Article  PubMed  Google Scholar 

  2. O’Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain. 2008;137:96–111.

    Article  PubMed  Google Scholar 

  3. Solaro C, Cella M, Signori A, Martinelli V, Radaelli M, Centonze D, Sica F, Grasso MG, Clemenzi A, Bonavita S, Esposito S, Patti F, D'Amico E, Cruccu G, Truini A, Neuropathic Pain Special Interest Group of the Italian Neurological Society. Identifying neuropathic pain in patients with multiple sclerosis: a cross-sectional multicenter study using highly specific criteria. J Neurol. 2018;265:82.

  4. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–5.

    Article  CAS  PubMed  Google Scholar 

  5. Osterberg A, Boivie J. Central pain in multiple sclerosis-sensory abnormalities. Eur J Pain. 2010;14:104–10.

    Article  CAS  PubMed  Google Scholar 

  6. Truini A, Galeotti F, La Cesa S, Di Rezze S, Biasiotta A, Di Stefano G, Tinelli E, Millefiorini E, Gatti A, Cruccu G. Mechanisms of pain in multiple sclerosis: a combined clinical and neurophysiological study. Pain. 2012;153:2048–54.

    Article  PubMed  Google Scholar 

  7. Gutrecht JA, Zamani AA, Slagado ED. Anatomic-radiologic basis of Lhermitte’s sign in multiple sclerosis. Arch Neurol. 1993;50:849–51.

    Article  CAS  PubMed  Google Scholar 

  8. Al-Araji AH, Oger J. Reappraisal of Lhermitte’s sign in multiple sclerosis. Mult Scler. 2005;11:398–402.

    Article  PubMed  Google Scholar 

  9. Kapoor R, Li YG, Smith KJ. Slow sodium-dependent potential oscillations contribute to ectopic firing in mammalian demyelinated axons. Brain. 1997;120:647–52.

    Article  PubMed  Google Scholar 

  10. Smith KJ, McDonald WI. The pathophysiology of multiple sclerosis: the mechanisms underlying the production of symptoms and the natural history of the disease. Philos Trans R Soc Lond B Biol Sci. 1999;354:1649–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26:831–49.

    Article  CAS  PubMed  Google Scholar 

  12. Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 2016;87:220–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cruccu G, Biasiotta A, Di Rezze S, Fiorelli M, Galeotti F, Innocenti P, Mameli S, Millefiorini E, Truini A. Trigeminal neuralgia and pain related to multiple sclerosis. Pain. 2009;143:186–91.

    Article  CAS  PubMed  Google Scholar 

  14. Nurmikko TJ. Pathophysiology of MS-related trigeminal neuralgia. Pain. 2009;143:165–6.

    Article  PubMed  Google Scholar 

  15. Di Stefano G, Tinelli E, Truini A. An unusual case of simultaneous bilateral trigeminal neuralgia due to multiple sclerosis. J Oral Facial Pain Headache. 2017;31(4):e4–e6.

    Article  PubMed  Google Scholar 

  16. Godazandeh K, Martinez Sosa S, Wu J, Zakrzewska JM. Trigeminal neuralgia: comparison of characteristics and impact in patients with or without multiple sclerosis. Mult Scler Relat Disord. 2019;34:41–6.

    Article  PubMed  Google Scholar 

  17. Ferraro D, Annovazzi P, Moccia M, Lanzillo R, De Luca G, Nociti V, Fantozzi R, Paolicelli D, Ragonese P, Gajofatto A, Boffa L, Cavalla P, Lo Fermo S, Buscarinu MC, Lorefice L, Cordioli C, Calabrese M, Gallo A, Pinardi F, Tortorella C, Di Filippo M, Camera V, Maniscalco GT, Radaelli M, Buttari F, Tomassini V, Cocco E, Gasperini C, Solaro C, RIREMS (Rising Researchers in Multiple Sclerosis). Characteristics and treatment of multiple sclerosis-related trigeminal neuralgia: an Italian multi-centre study. Mult Scler Relat Disord. 2019;37:101461.

  18. Chen DQ, DeSouza DD, Hayes DJ, Davis KD, O'Connor P, Hodaie M. Diffusivity signatures characterize trigeminal neuralgia associated with multiple sclerosis. Mult Scler. 2016;22:51–63.

    Article  CAS  PubMed  Google Scholar 

  19. Truini A, Prosperini L, Calistri V, Fiorelli M, Pozzilli C, Millefiorini E, Frontoni M, Cortese A, Caramia F, Cruccu G. A dual concurrent mechanism explains trigeminal neuralgia in patients with multiple sclerosis. Neurology. 2016;31:2094–9.

    Article  Google Scholar 

  20. Burchiel KJ. Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg. 1980;53:674–83.

    Article  CAS  PubMed  Google Scholar 

  21. Devor M, Govrin-Lippmann R, Rappaport ZH. Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery. J Neurosurg. 2002;96:532–43.

    Article  PubMed  Google Scholar 

  22. Truini A, Barbanti P, Pozzilli C, Cruccu G. A mechanism-based classification of pain in multiple sclerosis. J Neurol. 2013;260:351–67.

    Article  CAS  PubMed  Google Scholar 

  23. Matthews WB. Paroxysmal symptoms in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1975;38:617–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Spissu A, Cannas A, Ferrigno P, et al. Anatomic correlates of painful tonic spasms in multiple sclerosis. Mov Disord. 1999;14:331–5.

    Article  CAS  PubMed  Google Scholar 

  25. Markovà J, Essner U, Akmaz B, Marinelli M, Trompke C, Lentschat A, Vila C. Sativex® as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial. Int J Neurosci. 2019;129:119–28.

  26. van Amerongen G, Kanhai K, Baakman AC, Heuberger J, Klaassen E, Beumer TL, Strijers RLM, Killestein J, van Gerven J, Cohen A, Groeneveld GJ. Effects on spasticity and neuropathic pain of an oral formulation of Δ9-tetrahydrocannabinol in patients with progressive multiple sclerosis. Clin Ther. 2018;40:1467–82.

    Article  PubMed  CAS  Google Scholar 

  27. Corey-Bloom J, Wolfson T, Gamst A, Jin S, Marcotte TD, Bentley H, Gouaux B. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ. 2012;184:1143–50.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wissel J, Haydn T, Müller J, Brenneis C, Berger T, Poewe W, Schelosky LD. Low dose treatment with the synthetic cannabinoid nabilone significantly reduces spasticity-related pain: a double-blind placebo-controlled cross-over trial. J Neurol. 2006;253:1337–411.

    Article  CAS  PubMed  Google Scholar 

  29. Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A, UK MS Research Group. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet. 2003;362:1517–26.

  30. Hyman N, Barnes M, Bhakta B, Cozens A, Bakheit M, Kreczy-Kleedorfer B, Poewe W, Wissel J, Bain P, Glickman S, Sayer A, Richardson A, Dott C. Botulinum toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. J Neurol Neurosurg Psychiatry. 2000;68:707–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Cutter NC, Scott DD, Johnson JC, Whiteneck G. Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2000;81:164–9.

    Article  CAS  PubMed  Google Scholar 

  32. Mueller ME, Gruenthal M, Olson WL, Olson WH. Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis. Arch Phys Med Rehabil. 1997;78:521–4.

    Article  CAS  PubMed  Google Scholar 

  33. Middel B, Kuipers-Upmeijer H, Bouma J, Staal M, Oenema D, Postma T, Terpstra S, Stewart R. Effect of intrathecal baclofen delivered by an implanted programmable pump on health-related quality of life in patients with severe spasticity. J Neurol Neurosurg Psychiatry. 1997;63:204–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Sachais BA, Logue JN, Carey MS. Baclofen, a new antispastic drug. A controlled, multicenter trial in patients with multiple sclerosis. Arch Neurol. 1977;34:422–8.

  35. Schimrigk S, Marziniak M, Neubauer C, Kugler EM, Werner G, Abramov-Sommariva D. Dronabinol is a safe long-term treatment option for neuropathic pain patients. Eur Neurol. 2017;78:320–9.

    Article  CAS  PubMed  Google Scholar 

  36. Turcotte D, Doupe M, Torabi M, Gomori A, Ethans K, Esfahani F, Galloway K, Namaka M. Nabilone as an adjunctive to gabapentin for multiple sclerosis-induced neuropathic pain: a randomized controlled trial. Pain Med. 2015;16:149–59.

    Article  PubMed  Google Scholar 

  37. Vollmer TL, Robinson MJ, Risser RC, Malcolm SK. A randomized, double-blind, placebo-controlled trial of duloxetine for the treatment of pain in patients with multiple sclerosis. Pain Pract. 2014;14:732–44.

    Article  PubMed  Google Scholar 

  38. Langford RM, Mares J, Novotna A, Vachova M, Novakova I, Notcutt W, Ratcliffe S. A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. J Neurol. 2013;260:984–97.

    Article  CAS  PubMed  Google Scholar 

  39. Falah M, Madsen C, Holbech JV, Sindrup SH. A randomized, placebo-controlled trial of levetiracetam in central pain in multiple sclerosis. Eur J Pain. 2012;16:860–9.

    Article  CAS  PubMed  Google Scholar 

  40. Rossi S, Mataluni G, Codecà C, Fiore S, Buttari F, Musella A, Castelli M, Bernardi G, Centonze D. Effects of levetiracetam on chronic pain in multiple sclerosis: results of a pilot, randomized, placebo-controlled study. Eur J Neurol. 2009;16:360–6.

    Article  CAS  PubMed  Google Scholar 

  41. Breuer B, Pappagallo M, Knotkova H, Guleyupoglu N, Wallenstein S, Portenoy RK. A randomized, double-blind, placebo-controlled, two-period, crossover, pilot trial of lamotrigine in patients with central pain due to multiple sclerosis. Clin Ther. 2007;29:2022–30.

    Article  CAS  PubMed  Google Scholar 

  42. Rog DJ, Nurmikko TJ, Friede T, Young CA. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology. 2005;65:812–9.

    Article  PubMed  Google Scholar 

  43. Svendsen KB, Jensen TS, Bach FW. Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomised double blind placebo controlled crossover trial. BMJ. 2004;329:253.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sakurai M, Kanazawa I. Positive symptoms in multiple sclerosis: their treatment with sodium channel blockers, lidocaine and mexiletine. J Neurol Sci. 1999;162:162–8.

    Article  CAS  PubMed  Google Scholar 

  45. Zajicek JP, Hobart JC, Slade A, Barnes D, Mattison PG, MUSEC Research Group. Multiple sclerosis and extract of cannabis: results of the MUSEC trial. J Neurol Neurosurg Psychiatry. 2012;83:1125–32.

  46. Sharafaddinzadeh N, Moghtaderi A, Kashipazha D, Majdinasab N, Shalbafan B. The effect of low-dose naltrexone on quality of life of patients with multiple sclerosis: a randomized placebo-controlled trial. Mult Scler. 2010;16:964–9.

    Article  CAS  PubMed  Google Scholar 

  47. Cree BA, Kornyeyeva E, Goodin DS. Pilot trial of low dose naltrexone and quality of life in multiple sclerosis. Ann Neurol. 2010;68:145–50.

    CAS  PubMed  Google Scholar 

  48. Panitch HS, Thisted RA, Smith RA, Wynn DR, Wymer JP, Achiron A, Vollmer TL, Mandler RN, Dietrich DW, Fletcher M, Pope LE, Berg JE, Miller A, Psuedobulbar Affect in Multiple Sclerosis Study Group. Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 2006;59:780–87.

  49. Wade DT, Makela P, Robson P, House H, Bateman C. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler. 2004;10:434–41.

    Article  CAS  PubMed  Google Scholar 

  50. Wade DT, Robson P, House H, Makela P, Aram J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil. 2003;17:21–9.

    Article  PubMed  Google Scholar 

  51. Loder C, Allawi J, Horrobin DF. Treatment of multiple sclerosis with lofepramine, l-phenylalanine and vitamin B(12): mechanism of action and clinical importance: roles of the locus coeruleus and central noradrenergic systems. Med Hypotheses. 2002;59:594–602.

    Article  CAS  PubMed  Google Scholar 

  52. Rog DJ, Nurmikko TJ, Young CA. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther. 2007;29:2068–79.

    Article  CAS  PubMed  Google Scholar 

  53. Espir ML, Millac P. Treatment of paroxysmal disorders in multiple sclerosis with carbamazepine (Tegretol). J Neurol Neurosurg Psychiatry. 1970;33:528–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Lunardi G, Leandri M, Albano C, Cultrera S, Fracassi M, Rubino V, et al. Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia. Neurology. 1997;48:1714–7.

    Article  CAS  PubMed  Google Scholar 

  55. Leandri M, Lundardi G, Inglese M, et al. Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis. J Neurol. 2000;247:556–8.

    Article  CAS  PubMed  Google Scholar 

  56. Solaro C, Lunardi GL, Capello E, et al. An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology. 1998;51:609–11.

    Article  CAS  PubMed  Google Scholar 

  57. Khan OA. Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology. 1998;51:611–4.

    Article  CAS  PubMed  Google Scholar 

  58. Solaro C, Boehmker M, Tanganelli P. Pregabalin for treating paroxysmal painful symptoms in multiple sclerosis: a pilot study. J Neurol. 2009;256:1773–4.

    Article  PubMed  Google Scholar 

  59. Zvartau-Hind M, Din MU, Gilani A, Lisak RP, Khan OA. Topiramate relieves refractory trigeminal neuralgia in MS patients. Neurology. 2000;55:1587–8.

    Article  CAS  PubMed  Google Scholar 

  60. Solaro C, Uccelli MM, Brichetto G, Gaspperini C, Mancardi G. Topiramate relieves idiopathic and symptomatic trigeminal neuralgia. J Pain Symptom Manage. 2001;21:367–8.

    Article  CAS  PubMed  Google Scholar 

  61. Reder AT, Arnason BG. Trigeminal neuralgia in multiple sclerosis relieved by a prostaglandin E analogue. Neurology. 1995;45:1097–100.

    Article  CAS  PubMed  Google Scholar 

  62. Pfau G, Brinkers M, Treuheit T, Kretzschmar M, Sentürk M, Hachenberg T. Misoprostol as a therapeutic option for trigeminal neuralgia in patients with multiple sclerosis. Pain Med. 2012;13:1377–8.

    Article  PubMed  Google Scholar 

  63. DMKG study group. Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis. J Neurol. 2003;250:542–25.

    Article  CAS  Google Scholar 

  64. Solaro C, Uccelli MM, Guglieri P, et al. Gabapentin is effective in treating nocturnal painful spasms in multiple sclerosis. Mult Scler. 2000;6:192–3.

    Article  CAS  PubMed  Google Scholar 

  65. Solaro CM, Ferriero G. Refactory trigeminal neuralgia successfully treated by combination therapy (Pregabalin plus lamotrigine). Mult Scler Relat Disord. 2018;25:165–6.

    Article  PubMed  Google Scholar 

  66. Cianchetti C, Zuddas A, Randazzo AP, et al. Lamotrigine adjunctive therapy in painful phenomena in MS: preliminary observations. Neurology. 1999;53:433.

    Article  CAS  PubMed  Google Scholar 

  67. Restivo DA, Tinazzi M, Patti F, et al. Botulinum toxin treatment of painful tonic spasms in multiple sclerosis. Neurology. 2003;61:719–20.

    Article  CAS  PubMed  Google Scholar 

  68. Solaro C, Tanganelli P. Tiagabine for treating painful tonic spasms in multiple sclerosis: a pilot study. J Neurol Neurosurg Psychiatry. 2004;75:341.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14:162–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain. Eur J Neurol. 2010;2010(17):1113–e88.

    Article  Google Scholar 

  71. Cruccu G. Treatment of painful neuropathy. Curr Opin Neurol. 2007;20:531–5.

    Article  CAS  PubMed  Google Scholar 

  72. Hohmann AG, Tsou K, Walker JM. Cannabinoid modulation of wide dynamic range neurons in the lumbar dorsal horn of the rat by spinally administered WIN55,212–2. Neurosci Lett. 1998;257:119–22.

    Article  CAS  PubMed  Google Scholar 

  73. Shen M, Piser TM, Seybold VS, et al. Cannabinoid receptor agonists inhibit glutamatergic synaptic transmission in rat hippocampal cultures. J Neurosci. 1996;16:4322–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Wade DT, Makela PM, House H, Bateman C, Robson P. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler. 2006;12:639–45.

    Article  CAS  PubMed  Google Scholar 

  75. Ramsaransing G, Zwanikken C, De Keyser J. Worsening of symptoms of multiple sclerosis associated with carbamazepine. BMJ. 2000;320:1113.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Solaro C, Restivo D, Mancardi GL, Tanganelli P. Oxcarbazepine for treating paroxysmal painful symptoms in multiple sclerosis: a pilot study. Neurol Sci. 2007;28:156–8.

    Article  CAS  PubMed  Google Scholar 

  77. Mackay DD. Should patients with optic neuritis be treated with steroids? Curr Opin Ophthalmol. 2015;26(6):439–44.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Human Neuroscience, Sapienza University, viale Università 30, 00185, Rome, Italy

    Giulia Di Stefano, Gianfranco De Stefano, Andrea Di Lionardo, Giorgio Cruccu & Andrea Truini

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  1. Giulia Di Stefano
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  2. Gianfranco De Stefano
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  3. Andrea Di Lionardo
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  4. Giorgio Cruccu
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Correspondence to Giorgio Cruccu.

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Conflict of Interest

Giorgio Cruccu received a research grant, consulting fees, and payments for lectures from Alfasigma, and consulting fees from Angelini and Biogen. Andrea Truini received consulting fees or payment for lectures from Alfasigma, Angelini, Gruenenthal, and Pfizer. Giulia Di Stefano has no conflicts to declare. Gianfranco De Stefano has no conflicts to declare. Andrea Di Lionardo has no conflicts to declare.

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Di Stefano, G., De Stefano, G., Di Lionardo, A. et al. Pharmacotherapeutic Options for Managing Pain in Multiple Sclerosis. CNS Drugs 34, 749–761 (2020). https://doi.org/10.1007/s40263-020-00731-7

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