Analysis Of Clinical Characteristics And Influencing Factors Of Pain In Neuromyelitis Optic Spectrum Disorders

Objective:1.To investigate the incidence and clinical characteristics of pain in neuromyel itis optic spectrum disorders(NMOSD).2.To study the treatment status of patients with NMOSD pain.3.To explore the related factors affecting NMOSD pain.Methods:From July 2016 to June 2019,145 NMOSD patients who were hospitalized in the Department of Neurology of the first Hospital of Shanxi Medical University who met the2015 international diagnostic guidelines for NMOSD were collected retrospectively.The basic clinical information of all patients was collected,including sex,age,inducement,course of disease,annual recurrence rate,serum AQP4-ab status,EDSS score of the last follow-up and imaging features.To describe the clinical characteristics of pain in NMOSD patients during the course of disease,including pain location,type,duration,severity,time sequence of pain and other neurological symptoms,treatment status,comparison of the relationship between pain location and magnetic resonance lesion segments in NMOSD patients,univariate and multivariate Logistic regression analysis was used to analyze the related factors affecting NMOSD pain..Results:1.General clinical data : a total of 145 patients with NMOSD were included in this study,including 127 females and 18 males,with an averageage of 44.97 ±15.54,38.43 ±16.61 years old,an average course of 6.45 ±6.08 years,an average annual rec urrence rate of 0.93 ±0.63,and an average EDSS score of 3.56 ±1.55 during the la st follow-up.47 patients(32.4%)had predisposing factors before onset.Blood AQP4-ab(+)was found in 105 cases,blood AQP4-ab(-)in 30 cases,autoimmune disea ses in 42 cases,and autoimmune antibodies were detected in 79 cases(54.5%).Th Vere were 94 cases of optic nerve involvement and 128 cases of spinal cord involve ment,including cervical spinal cord involvement in 85 cases(66.4%),thoracic cord involvement in 99 cases(77.3%),cervicothoracic cord involvement in 55 cases(43.0%),and intracranial lesions were found in 82 cases(56.6%).The main initial symp toms were visual loss(50 cases),limb numbness(31 cases),intractable hiccup vomit ing(30 cases),limb pain(19 cases),limb weakness(17 cases),limb pruritus(3case s),diplopia(2 cases),ataxia(2 cases),somnolence(1 case)and defecation disturban ce(1 case).2.Clinical characteristics of pain: the incidence of NMOSD pain is 80.7%,including neuropathic pain,headache,ON-related eye pain,painful spas m and musculoskeletal pain,of which neuropathic pain is the most commo n(79.5%).NMOSD has a wide range of pain sites,the most common bein g the lower limbs and torso(24.8% in the back,22.2% in the abdomen,23.1% in the front chest),followed by the upper limb(24.8%)and the neck and shoulder(23.9%).The common properties of pain are bundle sensation,needling sensation and burning sensation.The degree of pain was mainly m oderate(77.8%),mild pain and severe pain accounted for 12.0% and 10.2%,respectively.According to the results of MRI,the spinal cord lesions were mainly involved in NP patients,and the location of pai was basically consi stent with that of MRI.Only 3 patients with NP did not correspond to the results of MRI.The location of NP in limbs and trunk can be used asone of the signs of segmental localization of spinal cord.MRI of headache pati ents mainly involved optic nerve or intracranial lesions(brainstem,high cer vical spinal cord).NP,headache and ON-related eye pain can all be the fi rst symptoms of the first or recurrent NMO,and painful spasms often occu r in the convalescent stage of NMOSD.About 60% of the patients need or al painkillers,and more than a half of patients need two kinds of painkille rs.The higher the NRS score,the worse the analgesic effect,and 58.6% o f the patients had poor analgesic effect.3.Treatment status:About 60% of patients need oral painkillers,of whi ch more than 1 stroke 2 patients need more than 2 kinds of painkillers,an d 58.6% of patients have poor analgesic effect.Pain spasm,headache,ONrelated eye pain treatment effect is obvious,the effective rate is more than83%;neuropathic pain treatment effect is poor,the effective rate is only 46%.4.Influencing factors of pain: univariate analysis showed that positive AQP4-ab and pruritus were the influencing factors of NMOSD pain.Binary Logistic regression analysis showed that positive serum AQP4-ab was an in dependent risk factor for NMOSD pain.Conclusion:1.The incidence of NMOSD pain is high,most of which are band-like,acupuncture-like and burning-like pain,mainly neuropathic pain,pain mainly occurs in the lower extremities and trunk,and the degree of pain is moderate.The location of neuropathic pain corresponds to the segment of spinal cord,which can be used as a sign of neurolocalization.Some patients with neuropathic pain,headache,ON-related eye pain as the first symptoms,need to guard against the recurrence of the disease,painful tonic spasm mostly occurs in the recovery stage of NMOSD.2.60% of the patients need oral painkillers,58.6% of the patients have poor analgesic effect;painful tonic spasm,headache,ON-related eye pain is better,neuropathic pain is not good.3.Patients with serum AQP4-ab(+)NMOSD were more likely to have pain than patients with serum AQP4-ab(-)NMOSD,and patients with pain were associated with pruritus.Serum AQP4-ab(+)is an independent risk factor for NMOSD pain.