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Sensory Symptoms and Pain

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In this article

Symptom: Sensory symptoms (parasthesias)

Tingling

Treatment

  • Gabapentin, pregabalin, tricyclic antidepressants
  • Other: acupuncture, reflexology, meditation

Symptom: Primary pain

Central neuropathic pain - continuous (dysesthesias)

Treatment

  • 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 (trigeminal neuralgia)

Treatment

  • First-line: carbamazepine 
  • Alternate options: oxcarbazepine, lamotrigine, baclofen
  • Additional options with lower levels of evidence: phenytoin, clonazepam, valproic acid, intranasal lidocaine
  • Other: behavioral self-management (mindful meditation); hypnosis; cognitive behavior therapy
  • therapy and acceptance commitment therapy (Harrison et al., 2017; Hughes et al., 2017; Cederberg et al, 2016; Baranoff et al, 2016)
  • Surgery: radiofrequency rhizotomy; radiofrequency electrocoagulation; glycerol rhizotomy

Psychosocial Implications for each pain symptom

  • mood changes; social isolation

Symptom: Secondary pain (musculoskeletal)

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

Treatment

  • Referral to PT: gait and balance training; assessment of all seating (home, automobile, work, and wheelchair/scooter)
  • analgesics including acetaminophen, ibuprofen, naproxen sodium

Resources for clinicians

Clinical Bulletin: Pain in Multiple Sclerosis (.pdf)

Resources for patients

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