Pain syndromes are common in MS, ranging from acute to chronic, from the “MS hug” to pain caused by spasticity, from neuropathic to musculoskeletal pain, and more.
In one study, 55 percent of people with MS had “clinically significant pain” at some time and 48 percent were troubled by chronic pain. This study suggested factors such as age at onset, length of time with MS and degree of disability played no part in distinguishing the people with pain from the people who were pain free. The study also indicated that twice as many women as men experienced pain as part of their MS.
For more detailed information about MS-related pain, review this professional paper and Momentum magazine article.
Acute pain is neurological in nature and is caused by “short circuiting” of the nerves that carry sensation. Acute pain includes:
- Trigeminal neuralgia (TN) is a stabbing pain in the face, and can occur as an initial symptom of MS. While it can be confused with dental pain, this pain is neuropathic in origin (caused by damage to the trigeminal nerve). It can usually be treated with medications such as the anticonvulsants carbamazepine (Tegretol®), oxcarbazepine (Trileptal®) and lamotrigine (Lamictal®).
- Lhermitte’s sign is a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward. Medications, including anticonvulsants, may be used to prevent the pain, or a soft collar may be used to limit neck flexion.
- Neuropathic pain is burning, stabbing or squeezing sensations around the body (sometimes referred to as the "MS hug"). These sensations come from damage to nerves in the central nervous system and are called dysesthesias.
These painful sensations—dysesthesias—typically affect the legs and feet but may also affect the arms and trunk (such as the feeling of constriction around the abdomen or chest area known as the "MS hug"). They can be very uncomfortable—even quite painful—but are not dangerous or necessarily disabling unless they are severe enough to interfere with a person's activities. Dysesthesias are treated:
- Often with the anticonvulsant medication gabapentin (Neurontin®).
- With an antidepressant such as amitriptyline (Elavil®) which modifies how the central nervous system reacts to pain.
- In other ways including wearing a pressure stocking or glove (which can convert the sensation of pain to one of pressure), warm compresses to the skin (which may convert the sensation of pain to one of warmth), and over-the-counter acetaminophen (Tylenol® and others) which may be taken daily under a physician’s supervision.
Other acute pain treatments include:
- Duloxetine hydrochloride (Cymbalta®) was approved by the Food & Drug Administration (FDA) in 2004 for treatment of depression and treatment of pain associated with diabetic peripheral neuropathy. Although not specifically approved for use in MS, its effectiveness in diabetic neuropathy makes it a suitable candidate for the treatment of neuropathic pain in MS, and many MS specialists consider it a good treatment option for people with MS.
- Pregabalin (Lyrica®), also approved by the FDA in 2004, is recommended for the treatment of neuropathic pain associated with diabetes, fibromyalgia and certain types of seizures. Although not specifically approved for use in MS, it is also considered a good treatment option for people with MS.
Burning, aching, prickling or “pins and needles” may be chronic rather than acute. The treatments are the same as for the acute dysesthesias described above.
Pain of spasticity has its own subcategories. Muscle spasms or cramps, called flexor spasms, may occur. Treatments include:
Medication with baclofen (Lioresal®) or tizanidine (Zanaflex®), ibuprofen, or other prescription strength anti-inflammatory agents.
Regular stretching exercises and balancing water intake with adequate sodium and potassium, as shortages in either of these can cause muscle cramps.
Tightness and aching in joints is another manifestation of spasticity, and generally responds well to the treatments described above.
Back and other musculoskeletal pain in MS can have many causes, including spasticity. Pressure on the body caused by immobility, incorrect use of mobility aids, or the struggle to compensate for gait and balance problems may all contribute. An evaluation to pinpoint the source of the pain is essential. Treatments may include heat, massage, ultrasound, physical therapy and treatment for spasticity.
For more detailed information about the treatment of MS-related pain, click here.
Emotional changes, including fear and worry, may contribute to physical pain.
- A multidisciplinary pain clinic may be able to treat chronic disabling pain with medication in combination with alternative therapies such as biofeedback, hypnosis, yoga, meditation or acupuncture.
- Self-help and/or group support may also play an important role in pain control.
- People who stay active and maintain positive attitudes are often able to reduce the impact of pain on their quality of life.