PT  - JOURNAL ARTICLE
AU  - George Tackley
AU  - Domizia Vecchio
AU  - Shahd Hamid
AU  - Maciej Jurynczyk
AU  - Yazhuo Kong
AU  - Rosie Gore
AU  - Kerry Mutch
AU  - Mark Woodhall
AU  - Patrick Waters
AU  - Angela Vincent
AU  - Maria Isabel Leite
AU  - Irene Tracey
AU  - Anu Jacob
AU  - Jacqueline Palace
TI  - Chronic neuropathic pain severity is determined by lesion level in aquaporin 4-antibody-positive myelitis
AID  - 10.1136/jnnp-2016-314991
DP  - 2017 Feb 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 165--169
VI  - 88
IP  - 2
4099  - http://jnnp.bmj.com/content/88/2/165.short
4100  - http://jnnp.bmj.com/content/88/2/165.full
SO  - J Neurol Neurosurg Psychiatry2017 Feb 01; 88
AB  - Importance Chronic, intractable neuropathic pain is a common and debilitating consequence of neuromyelitis optica spectrum disorder (NMOSD) myelitis, with no satisfactory treatment; few studies have yet to explore its aetiology.Objective To establish if myelitis-associated chronic pain in NMOSD is related to the craniocaudal location of spinal cord lesions.Method (1) Retrospective cohort of 76 aquaporin 4-antibody (AQP4-Ab)-positive patients from Oxford and Liverpool's national NMOSD clinics, assessing current pain and craniocaudal location of cord lesion contemporary to pain onset. (2) Focused prospective study of 26 AQP4-Ab-positive Oxford patients, a subset of the retrospective cohort, assessing current craniocaudal lesion location and current pain.Results Patients with isolated thoracic cord myelitis at the time of pain onset were significantly more disabled and suffered more pain. Cervical and thoracic lesions that persisted from pain onset to ‘out of relapse’ follow-up (current MRI) had highly significant (p<0.01) opposing effects on pain scores (std. β=−0.46 and 0.48, respectively). Lesion length, total lesion burden and number of transverse myelitis relapses did not correlate with pain.Conclusions Persistent, caudally located (ie, thoracic) cord lesions in AQP4-Ab-positive patients associate with high postmyelitis chronic pain scores, irrespective of number of myelitis relapses, lesion length and lesion burden. Although disability correlated with pain in isolation, it became an insignificant predictor of pain when analysed alongside craniocaudal location of lesions.