Pain has been considered rather uncommon in multiple sclerosis, as a survey of textbooks will reveal. Yet in a necropsy study of 46 cases, Carter et al1 recorded pain in 42% of them and it was the first symptom in 11%. Their patients had a severe form of the disease, having reached the hospital and remained there until death.
McAlpine et al2 found that pain, especially in the low back, may be early or late in the course of the disease. They noted that Abb and Schaltenbrand defined a pseudorheumatic type of multiple sclerosis characterized by muscle and joint pains or by neuralgia, but without fever. Pain in the limbs occurred in about one third of the patients of McAlpine et al with the spinal form of the disease, but girdle pain and neck pain were rarer. Head pain or trigeminal neuralgia are unusual in multiple sclerosis. However,