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Nerve pain alone was the least common pain experience, according to a survey of 842 people with MS with chronic pain. Specific types of pain are treated differently. So, it is crucial to understand the origin of pain in a person with MS to optimize  strategies that bring relief.

• Several types of pain occur in people with MS.
  • “Neuropathic” pain happens from “short circuiting” of the nerves that carry signals from the body to the brain because of damage from MS. These pain sensations feel like burning, stabbing, sharp and squeezing sensations.
  • “Nociceptive” pain occurs when pain receptors known as nocireceptors are activated– in MS, this might result from musculoskeletal issues such as injuries, muscle spasms, stiffness or weakness.
  • “Nociplastic” pain, which occurs when the central nervous system mistakenly perceives pain from nonpainful stimulation -- for example, pain from damaged tissue that persists after the damage has healed.
• The team used an online survey that included clinical measures that assess pain, the existence of overlapping pain conditions, and the use of pain medications and other pain treatments. They analyzed data of 842 respondents with MS who had pain lasting at least three months.
• The largest proportion (41%) had nociceptive pain, 9% had neuropathic pain alone, and 27% had a combination of neuropathic and nociplastic pain. Nociplastic pain was associated with significantly higher pain intensity and frequency of chronic overlapping pain conditions. Migraine was the most common overlapping pain condition.
• Non-steroidal anti-inflammatory drugs (NSAIDS – such as Tylenol) were the most commonly used (66.5%) for all pain types. Participants with nociplastic or mixed nociplastic/neuropathic pain most frequently reported use of cannabis-based treatments and narcotic pain medications. Pain relief respondents experienced by respondents varied. Cannabis products provided significantly more pain relief for those with mixed pain compared to neuropathic pain, and NSAIDS provided greater relief for those with nociceptive pain compared to nociplastic pain.
• These results highlight the importance that healthcare providers try to identify the origin/types of pain an individual is experiencing to optimize relief efforts.
• Learn more about pain. Get a handle on this MS symptom, including treatment beyond medication.

 “Characterizing chronic pain phenotypes in MS” by Anna Kratz, PhD and Tiffany Braley, MD, MS, (University of Michigan) and colleagues from the University of Washington is published in Pain (published online 11/3/2020).