PAIN IN GUILLAIN-BARRE-SYNDROME

Objectives: To determine the character, intensity and frequency of pai n in Guillain-Barre syndrome (GBS) and to evaluate the response to tre atment. Design: A prospective longitudinal study. Setting: Academic ho spital-based practices. Patients: Fifty-five consecutive patients with GBS. Interventions: Patients were evaluated on admission and at 2, 4, 8, 16, and 24 weeks. Main. outcome measures: Character of pain, pain intensity using Visual Analogue Scale ([VAS] 0 to 10 cm) and Present P ain Intensity of McGill Pain Questionnaire, pain relief (VAS 0 to 10 c m), Disability Grading Scale for GBS. Results: Forty-nine patients (89 .1%) described pain during the course of their illness. On admission, mean pain intensity (VAS) was 4.7 +/- 3.3. However, 26 patients (47.3% ) described pain that was either distressing, horrible, or excruciatin g (mean VAS, 7.0 +/- 2.0). The most common pain syndromes observed wer e deep aching back and leg pain and dysesthetic extremity pain. Pain i ntensity on admission correlated poorly with neurologic disability on admission (r = 0.26, p = 0.06) and throughout the period of study (r < 0.20, p > 0.10). Forty-one patients (74.5%) required opioid analgesic s, with 16 (29.0%) receiving parenteral morphine to provide adequate p ain relief. Conclusions: Moderate to severe pain is a common and early symptom of GBS and requires aggressive treatment. Pain intensity on a dmission is not a predictor of poor prognosis. Back and leg pain usual ly resolves over the first 8 weeks, but dysesthetic extremity pain may persist longer in 5 to 10% of patients despite motor recovery and the use of adjuvant analgesics.