Bozhenko M. Pain syndromes in patients with multiple sclerosis: clinical-neurological, neuropsychological and neuroimaging features.

The Ph.D. thesis presents the analysis and generalization of the main results of complex clinical-neurological and neuroimaging studies in patients with MS. According to the results of the Ph.D. thesis, new data were obtained on the prevalence, structure and characteristics of pain syndromes in patients with MS and their influence on the formation of the quality-of-life structure. We presented a new approach for improvement of the diagnosis and prediction of the pain syndromes structure in patients with MS, taking into account psycho-emotional and social factors, and identified new diagnostic neuroimaging markers of this disease by analyzing the volumes of brain structures based on MRI diagnostic data. As a result of a complex clinical and neurological analysis, we found that the prevalence of pain syndromes among MS patients was 86.7%, a significant part of MS patients (37.5±4.8%) had more than one type of pain. The median of average pain intensity was 5 [3.75;7] points on the VAS scale. Among patients with MS, 24.0% had low-intensity pain, 54.8% moderate, and 21.2% high intensity pain. In patients with MS with 2-3 types of pain, compared to patients with only one type of pain, all indicators of pain intensity were significantly higher (p<0.05). When analyzing potential markers that could objectify the quality of life, we found that asymmetry between the right and left thalamus in the direction of left thalamus volume decrease in relation to the right, had a pronounced relationship with a decrease in the physical quality of life (r=-0.679, p=0.003), namely its component as physical functioning (r=-0.697, p=0.010). Physical functioning was also related to the volume of the thalamus (r=0.509, p=0.037). In order to improve diagnostic and prognostic capabilities, we developed a prognostic model of neuropathic pain in MS patients. It helps to assess the risk of neuropathic pain and demonstrates risk factors, the correction of which can prevent the occurrence of this type of pain in MS patients. We developed the Multiple Sclerosis Neuropathic Pain Questionnaire (MSNP), which allows the detection of neuropathic pain in MS patients without significant additional time. The sensitivity of the questionnaire is 94.1%, and the specificity is 81.6%. Thus, the overall accuracy of the questionnaire is 83.7%. It is convenient and can be recommended for use in clinical practice.