Association of Neuromyelitis Optica With Severe and Intractable Pain

Abstract

Longitudinally extensive transverse myelitis from neuromyelitis optica (NMO) may result in poor recovery, severe disability, and decreased survival.^1,2 Neuromyelitis optica is associated with extensive spinal cord injury, and autopsy series have noted axonal loss, cavitation, and necrosis.^3,4 Multiple sclerosis (MS) commonly affects the spinal cord, as noted in 83% by magnetic resonance imaging (MRI) and up to 99% at autopsy.^5,6 However, transverse myelitis from MS is typically not as fulminant compared with NMO, with less motor involvement and greater chance for recovery.⁷ At autopsy, myelitis from MS is characteristically partial, is associated with fewer spinal levels, and demonstrates relative axonal preservation.