RESEARCH: Pain in MSA & PAF

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J R Soc Med 1998 Jul;91(7):355-9

Neck and other muscle pains in autonomic failure: their association with

orthostatic hypotension.

Bleasdale-Barr KM, Mathias CJ.

University Department of Clinical Neurology, National Hospital for Neurology

& Neurosurgery, London, UK.

Neck pain in the suboccipital and paracervical region ('coathanger'

configuration) is often reported by patients with autonomic failure and

orthostatic hypotension. The frequency of this pain, along with pains in the

buttock and calf regions, was determined by questionnaire in two major

groups with primary chronic autonomic failure--pure autonomic failure (PAF)

and multiple system atrophy (MSA). Comparisons were made with Parkinson's

disease, cerebellar degeneration and other disorders in which neurological

symptoms overlap but in which there was neither autonomic failure nor

orthostatic hypotension. Neck pain was present in 93% of patients with PAF,

51% of patients with MSA and 38-47% of the non-autonomic groups. Buttock

pain was present in smaller but similar proportions (8-19%) of each group,

like calf pain (23-37%). Neck pain in PAF and MSA differed from that in the

other groups in being relieved by sitting or lying flat and in being

associated with factors that lower blood pressure in these patients. Buttock

pain was posturally related in PAF and MSA; for calf pain there was no

difference between groups. Neck pain was related to the degree of

orthostatic hypotension; in PAF patients, whose postural blood-pressure fall

was greater than that in MSA, there was a greater frequency of neck pain.

PMID: 9771493 [PubMed - indexed for MEDLINE]