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Pain & Itching

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Overview

Pain is a very personal experience, one that you can feel but others cannot see.  It is common in MS and can limit your ability to do things that you enjoy. Some types of pain are a direct result of MS and are caused by damage to nerves in the central nervous system. Other types of pain are because of changes to your body because of MS.  For example, you may have weakness in your leg and now walk differently, causing pain in your back and hip. This pain is from something else MS has caused (weakness).  Also, you may experience aches and pains that anyone can get and are not connected to your MS at all, like a toothache or stomach pain.

The type of pain that comes directly from the damage to nerves in MS is called neuropathic pain.  Pain that comes from weakness, stiffness or other mobility problems from MS is considered musculoskeletal pain. Both types of pain can be acute, having a rapid onset and short duration, or chronic, starting gradually and persisting daily or almost every day. The key is to identify the type of pain and treat the source of it.   

Neuropathic pain

Neuropathic pain happens from “short circuiting” of the nerves that carry signals from the brain to the body because of damage from MS. These pain sensations feel like burning, stabbing, sharp and squeezing sensations. In MS you can experience acute neuropathic pain and chronic neuropathic pain.

Acute Neuropathic Pain is sometimes an initial symptom of MS or may be part of an MS relapse. Acute means it has a rapid onset and is of short duration. Types of acute neuropathic pain include:

  • Trigeminal neuralgia (TN) - a stabbing pain in the face or jaw area that can occur as an initial symptom of MS or as a relapse. While it can be confused with dental pain, this pain is neuropathic in origin (caused by damage to the trigeminal nerve). This pain often comes and goes and it is unpredictable when it might occur. 
  • Lhermitte’s sign - a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine and often into the arms or legs, brought on by bending the neck forward. It typically means there is or has been damage from MS in the cervical spine (neck). When this happens for the first time it could be a relapse or a first sign of MS. 
  • MS Hug - a squeezing sensation around the torso that feels like a blood pressure cuff when it tightens. This too is from damage to the spine from MS and could be a first symptom of MS or a relapse.
  • Paroxysmal spasms - intermittent and painful tightening of muscles, such as in your arm or leg that may occur many times throughout the day or night.
If you are experiencing any of these pain sensations described above for the first time you should contact your healthcare provider. You might need further evaluation and treatment.

Chronic neuropathic pain

Chronic neuropathic pain is typically the persistence of an acute pain like those described above. In MS these pains can be experienced on a daily or nearly daily basis and often it is unpredictable when they will occur. If you have experienced an acute neuropathic pain before it’s possible for it to become a chronic neuropathic pain. There are things that can increase the likelihood for you to experience these pains, like increased stress, fatigue, illnesses, and being overheated. Most often those pain sensations will often settle down once you remove the trigger for them. In addition to the acute pains described above, people with MS can experience ongoing, less specific nerve pains called dysesthesias.   
  • Dysesthesias - a type of chronic pain that is not typically associated with a relapse. These are painful sensations that can affect the legs, feet, arms and hands and feel like burning, prickling, stabbing, ice cold or electrical sensations. They can interfere with daily activities, sleep and overall quality of life.
  • Pruritis (itching) is a form of dysesthesias and may occur as a symptom of MS. It is one of the family of abnormal sensations — such as “pins and needles” and burning, stabbing, or tearing pains — which may be experienced by people with MS. These sensations are known as dysesthesias, and they are neurologic in origin.

Musculoskeletal pain

Musculoskeletal pain is typically caused by an injury, like a sprained ankle, or a pulled muscle. In MS musculoskeletal pain occurs because of weakness, stiffness or coordination problems that alter your walking or other mobility.  Like in the example mentioned earlier, if you have leg weakness it’s likely you do not have the same gait (walk) that you did before MS. Chances are you swing your leg, or hike up your hip to avoid tripping.  Or it’s possible that you have trouble lifting your toes up when you walk, and you catch your foot on things and trip. These are called compensatory gaits and can cause discomfort - often in the back and/or hip.  In addition, a fall because of muscle weakness can cause injury and pain. 

Tightness or stiffness of the muscles, called spasticity, is caused directly by MS. Spasticity, will alter walking and cause pulling on the joints. This can result in pain typically in the ankles, knees, hips and back.

Treatment

Pain can be treated with both pharmacologic (medication) and non-pharmacologic (not using medication) interventions. Treatment should be designed to address the cause or source of your pain. For example, if you have back and hip pain from an abnormal gait because of leg weakness, the treatment should be designed to improve strength and gait rather than just treat the pain. Spasticity management may include medication to lessen the stiffness and stretching exercises that can reduce stiffness.

Neuropathic pain from MS is treated differently than other types of pain.  It does not usually respond to Tylenol® or Motrin® like other pains do.  Also, it generally does not respond to strong medications, called narcotics or opioids, that are sometimes used to treat pain after surgery. Neuropathic pain is treated with medications that settle down nerve overactivity. The medications generally used to treat neuropathic pain, both acute and chronic forms, include anti-seizure medications and certain types of antidepressants. These medications are not approved for use to treat pain from MS by the Food and Drug Administration (FDA) and are used “off-label” in MS.      

Below are examples of some common approaches to treating the different types of pain experienced with MS. Before starting any treatment, prescription or over-the-counter, please discuss with your healthcare provider.
Type of Pain Pharmacologic Treatments Non-Pharmacologic Treatments
Neuropathic pain (including dysesthetic itching) Anti-seizure medications
Certain anti-depressant medications
Acupuncture
Mindfulness and meditation
Cognitive Behavioral Therapy
Musculoskeletal pain Analgesic medications
Non-steroidal anti-inflammatory drugs (NSAIDs)
Physical therapy
Massage
Application of cold or heat
Spasticity Muscle relaxant medications Stretching exercises
Aqua therapy in non-heated pool

Impact of pain

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.

Additional resources

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Managing Pain and Sleep in MS

Pain and sleep disorders often cause confusion and frustration for people with MS, their loved ones, and healthcare providers. Learn from scientists and clinicians about strategies for symptom management, available treatment options, and ongoing research to identify the cause of pain and sleep disorders in MS. Download a copy of the companion book.

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