Sensory Symptoms and Pain - National Multiple Sclerosis Society

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Sensory Symptoms and Pain

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Symptom: Sensory symptoms (parasthesias)

Numbness, tingling, pins and needles

Treatment

No treatment required unless interfering with function; medication if necessary; referral to PT/OT if necessary

Symptom: Primary pain

Central neuropathic pain - continuous (dysesthesias)

Treatment

Medications:

  • tricyclic antidepressant medications (amitriptyline, nortriptyline, desipramine); antiepileptic medications (pregabalin, gabapentin) 

Other:

  • topical appliation of  capsaic acid cream;behavioral self-management (mindfulness,meditation)
  • hypnosis,cognitive behavior therapy

Central neuropathic pain - intermittent (trigeminalneuralgia)

Treatment

Medications

  • First-line: carbamazepine 
  • Alternate options: oxcarbazepine, lamotrigine, baclofen
  • Additional options with lower levels of evidence: phenytoin, clonazepam, valproic acid, intranasal lidocaine

Surgery:

  • radiofrequency rhizotomy; radiofrequency electrocoagulation; glycerol rhizotomy

Retro-orbital pain

Treatment

Medications:

  • High-dose IV steroids

Psychosocial Implications for each pain symptom

  • Clumsiness, balance problems, and loss of dexterity from sensory loss
  • Discomfort that is sometimes excruciating
  • Increase in fatigue caused by medications and interrupted sleep

Note: People often told by doctors that MS does not cause pain. Yet chronic pain is distracting, depressing, and debilitating.

Symptom: Secondary pain (musculoskeletal)

Resulting from poor posture/balance in ambulatory individuals or improper use/fitting of wheelchair

Treatment

Interventions:

  • Referral to PT: gait and balance training; assessment of all seating (home, automobile, work, and wheelchair/scooter);

Medications:

  • analgesics

Resources for clinicians

Clinical Bulletin: Pain in Multiple Sclerosis (.pdf)

Resources for patients

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