Constipation may worsen neuropathic pain in patients diagnosed with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD), according to results obtained from an online patient survey published in Multiple Sclerosis and Related Disorders.

The researchers noted a possible link between constipation severity and increased neuropathic pain in their clinical practice. They conducted an online survey sent to around 3000 members of closed Facebook groups with a global representation. Of the 3000 possible respondents, 317 (81.7% female) completed the survey.

Of these 317 respondents, 213 (67.2%) had a diagnosis of aquaporin-4 (AQP4) positive NMOSD, 93 (29.4%) had a diagnosis of MOGAD, and 11 (3.4%) had double-seronegative NMOSD. Most of these patients (85.2%) received disease-modifying therapies, including rituximab (49.8%), mycophenolate mofetil (11.9%), intravenous immunoglobulin therapy (8.6%), oral corticosteroids (8.2%), and azathioprine (7.1%).

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Of those completing the survey, 206 (65%) reported neuropathic pain, 167 (52.7%) reported constipation, and 137 of the 206 (66%) patients with neuropathic pain simultaneously experienced constipation. Of the 167 patients with constipation, 67 (40.2%) took at least 1 medication to treat this symptom, while the remaining 100 (59.9%) remained untreated.

These 2 symptoms appeared more frequently in patients with a history of myelitis with 74.8% of these patients experiencing neuropathic pain and 60.6% experiencing constipation. The investigators did not observe significant differences in the rate of neuropathic pain between the AQP4-positive NMOSD and MOGAD groups (P =.0659).

Forty-seven (34.3%) patients with NMOSD and MOGAD who experienced both neuropathic pain and constipation believed that the severity of neuropathic pain increased when constipation severity increased. On the contrary, they reported that neuropathic pain lessened when constipation lessened.

“The possible association opens a possibility of a new approach to managing [neuropathic pain], which tends to be poorly responsive to symptomatic therapies and is associated with worse quality of life in NMOSD and MOGAD,” the authors said. “The preliminary evidence generated by our survey provides motivation to initiate a prospective interventional study on the effects on [neuropathic pain] of bowel regimen in patients with constipation.”


Lotan I, Romanow G, Levy M, Kister I. Is there a link between neuropathic pain and constipation in NMOSD and MOGAD? Results from an online patient survey and possible clinical implications. Mult Scler Relat Disord. Published online April 26, 2022:103825. doi:10.1016/j.msard.2022.103825