UPPER-LIMB PAIN IN CHRONIC DEMYELINATING POLYNEUROPATHY - ELECTROPHYSIOLOGICAL CORRELATES

Pain is not usually considered a symptom of chronic relapsing demyelin ating polyneuropathy. We report two patients with chronic demyelinatin g polyneuropathies in whom clinical and electrophysiological worsening was associated with the development of deep and distressing upper lim b aching discomfort. One patient had a MGUS-associated hypertrophic de myelinating and prednisone-dependent polyneuropathy, followed over a c ourse of two and a half years. His discomfort regularly predicted elec trophysiological relapse of neuropathy, before more obvious clinical s igns had emerged. Resolution of the discomfort also predicted subseque nt clinical and electrophysiological improvement. Upper limb pain may be an important feature of early relapse in some patients with demyeli nating polyneuropathies. Standardized serial electrophysiological test ing in patients with chronic demyelinating polyneuropathy can be an im portant management tool in conjunction with clinical signs and symptom s.