Management of neuropathic pain and paresthesia in patients with multiple sclerosis: A systematic review and network meta-analysis.

BACKGROUND: Disability measures in multiple sclerosis (MS) have been heavily weighted towards motor function and ambulation. Pain and paresthesia are among the most common presenting symptoms in MS, which have a significant impact on quality of life and need to be treated appropriately. METHODS: The PubMed, Web of Science, Scopus, and Embase databases were searched. Final papers meeting the inclusion criteria were scored with the NIH quality assessment tool for quality and included in a network analysis. Eighteen papers in the analysis totaled 1723 participants. The interventions were grouped into pharmacological and non-pharmacological subcategories. RESULTS: In general, there was no significant difference in the effectiveness of any of the interventions compared to the sham/placebo treatment groups for neuropathic pain and paresthesia. However, for neuropathic pain, the ranking of interventions based on mean differences indicates that electrical stimulation, CBM, Duloxetine, Levetiracetam, and Amiloride were significantly more effective than sham/placebo treatment. Riluzol, Fluoxetine, and Lamotrigine were not effective on neuropathic pain. Furthermore, Nortriptyline and electrical stimulation were equally effective. For paresthesia, the ranking of interventions based on mean differences indicates that aquatic exercise, yoga, Acceptance and Commitment Therapy, pressure and massage, and Mindfulness-Based Stress Reduction were significantly more effective than control/sham treatment. In contrast, endurance training, coordinative training, and magnetic field therapy were as effective as sham treatment. CONCLUSION: In managing MS-related neuropathic pain and paresthesia, a combination of pharmacological and non-pharmacological interventions may provide the best outcomes.