ORIGINAL ARTICLE Pain in the acute phase of Guillain–Barr  e syndrome Masato Kinboshi, 1 Manabu Inoue, 1,2 Yasuhiro Kojima, 1 Michio Ono, 1 Tomokazu Nakagawa, 1,3 Masutaro Kanda 1 and Hiroshi Shibasaki 4 1 Department of Neurology, Ijinkai Takeda General Hospital, Kyoto, Japan, 2 Department of Neurology, Kansaidenryoku Hospital, 3 Department of Neurology, Kitano Hospital, Osaka, Japan, and 4 Kyoto University Graduate School of Medicine, Kyoto, Japan Key words delay in diagnosis, delay in treatment, Guillain–Barr e syndrome, pain, prognosis. Accepted for publication 11 April 2014. Correspondence Masato Kinboshi, 28-1 Ishida Moriminami- machi, Hushimi-ku, Kyoto city, Kyoto, Japan. Email: kinmasato@wd6.so-net.ne.jp Abstract Background and Aim: Pain has not been recognized as a main feature of Guillain– Barr e syndrome (GBS) in its acute phase. The pathophysiology of pain and its effect on the prognostic outcome of GBS have not been fully evaluated. The aim of the present study was to report the clinical features and prognosis of GBS patients presenting with pain in the acute phase. Methods: This was a retrospective study of 34 consecutive patients with GBS. We compared clinical profiles and laboratory findings between the GBS patients with pain and those without pain. Results: A total of 29% of GBS patients had pain in the acute phase. Among oth- ers, low back pain was most common. GBS patients with pain were significantly younger than those without pain. In GBS patients with pain, the time of admis- sion, the time for starting treatment and the time of discharge from the hospital were significantly delayed as compared with those without pain. However, there was no difference in the preceding infections, laboratory findings, or disability at the time of nadir and discharge. Conclusion: Pain is relatively common in the acute phase of GBS. Young GBS patients are especially susceptible to pain. Pain in the acute phase of GBS delays the time for reaching the correct diagnosis, and prolongs the duration of hospital stay and recovery, although it does not influence the functional prognosis. Introduction Guillain–Barr e syndrome (GBS) is an immune-mediated acute polyneuritis with a variable degree of motor weakness. The main clinical feature of GBS is rapidly progressive sym- metric motor weakness and areflexia of limbs, often after infection. Pain has been reported to occur with various fre- quency in the acute phase of GBS and to be severe in some cases. 1–7 Pain in GBS tends to be overlooked, because most attention is paid to motor weakness. In particular, pain occurring before the onset of motor weakness tends to pre- vent early diagnosis of GBS. 8,9 The aforementioned back- ground urged us to report the clinical features and prognosis of GBS patients presenting with pain in the acute phase. Methods We retrospectively reviewed the medical records of patients with clinical diagnosis of GBS admitted to Ijinkai Takeda General Hospital, Kyoto, Japan, during the past 12 years. A total of 34 patients fulfilled the diagnostic criteria of GBS. 10 Patients with Fisher syndrome and Bickerstaff brain- stem encephalitis were excluded. Data collected in the pres- ent study included age, sex, preceding infections, time of admission to the hospital, initiation of treatment, discharge from the hospital after the onset of neurological symptoms, neurological findings, cerebrospinal fluid (CSF), electrophys- iological findings and prognostic outcome. Regarding the classification of pain, the presence of radicular pain and painful paresthesia was regarded as characteristics of neural origin (neuralgia), whereas the presence of muscle pain, muscle strain and cramp was regarded as the pain of muscle origin (myalgia). At the point of nadir during the hospital stay, the disability of each patient was scored using the dis- ability grading scale proposed by Hughes et al. 11 Electro- physiological findings were classified by the criteria reported by Ho et al. 12 According to the presence or absence of pain in the acute phase, patients were divided into two groups (with pain and without pain). The values of each item in each group are expressed as means Æ standard error. For continuous variables, the t-test was used for parametric variables, and the Mann–Whitney U-test was used for non-parametric variables. The statistical significance of differences for categorical variables was 50 Neurology and Clinical Neuroscience 2 (2014) 50–53 ª 2014 Japanese Society of Neurology and Wiley Publishing Asia Pty Ltd doi:10.1111/ncn3.84