Comorbidities and Pain Management in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic immune-mediated disorder characterised by demyelination and neurodegeneration within the central nervous system. Beyond neurological disability, people with MS frequently present with a spectrum of comorbidities—most notably mood disorders, cardiovascular risk factors and other autoimmune conditions—that influence disease course, quality of life and treatment tolerance. Pain represents one of the most disabling symptoms in MS, with neuropathic pain syndromes, spasticity-related discomfort, musculoskeletal pain and headache each contributing significantly to functional impairment. Effective pain management in MS requires a comprehensive approach that addresses central and peripheral mechanisms, integrates disease-modifying therapies with symptomatic treatments, and harnesses non-pharmacological strategies such as physiotherapy and cognitive-behavioural interventions. Recognition and proactive management of comorbidities—particularly depression, anxiety and migraine—are crucial to optimising overall outcomes, as these conditions can exacerbate pain perception and undermine adherence to therapies. Recent advances in precision medicine have begun to inform individualised treatment plans, balancing efficacy and safety in a population characterised by heterogeneous clinical trajectories and diverse comorbidity profiles.

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Comorbidities and Pain Management in Multiple Sclerosis publication trend

The graph below shows the total number of articles in comorbidities and pain management in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Multiple sclerosis (MS): A chronic autoimmune disease characterised by demyelination and neurodegeneration within the central nervous system.

Comorbidity: The presence of one or more additional medical conditions co-occurring with a primary condition, affecting disease progression and management.

Neuropathic pain: Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system, common in MS due to demyelination of pain pathways.

Disease-modifying therapy (DMT): Treatments aimed at altering the underlying immune-mediated pathology of MS to reduce relapse frequency and delay disability progression.

Calcitonin gene-related peptide (CGRP): A neuropeptide involved in migraine pathophysiology; antagonism of CGRP signalling is a target for migraine prevention.

References

1. The anti-CGRP mAb Fremanezumab reverts the anti-inflammatory effects of CGRP in vitro but does not alter disease evolution in a mouse model of progressive multiple sclerosis. European Journal of Pharmacology (2025).
2. The epidemiology of primary headaches in patients with multiple sclerosis. Brain and Behavior (2020).
3. Headache in Multiple Sclerosis: A Narrative Review. Medicina (2024).