Posted by: Thixia | March 5, 2008

MS Pain

Pain:

Pain syndromes are not uncommon in MS. In one study, 55% of the people studied had what is called “clinically significant pain” at some time during the course of a lifetime with MS. Almost half (48%) were troubled by chronic pain. This study suggested that factors such as age at onset, length of time with MS, or 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.

Several Sources and Types of Pain in MS

Acute Pain:

• Trigeminal neuralgia is a stabbing pain in the face. It can occur as an initial symptom of MS. While it can be confused with dental pain, this pain is neuropathic (caused by damage to the trigeminal nerve) in origin. It can usually be treated successfully with medications such as the anticonvulsants carbamazepine (Tegretol® ) or phenytoin (Dilantin®).
• 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.
• Burning, Aching, or “Girdling” around the Body are all neurologic in origin. The technical name for them is dysesthesias . These pains are often treated with the anticonvulsant medication gabapentin (Neurontin®). Dysesthesias may also be treated with an antidepressant such as amitriptyline (Elavil® ), which modifies how the central nervous system reacts to pain. Other treatments include 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. Duloxetine hydrochloride (Cymbalta®) was approved by the U.S. Food and Drug Administration (FDA) in 2004 for the treatment of depression and the treatment of pain associated with diabetic peripheral neuropathy. Cymbalta® belongs to the group of medications known as selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). 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 MS specialists physicians consider it a good treatment option for people with MS.

Chronic Pain:
• Burning, Aching, Prickling, or “Pin 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. Treatment also includes 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 treatment described above.
• Back and Other Musculoskeletal Pain in MS can have many causes, including spasticity. Pressure on the body caused by immobility, or 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.

Pain and the Emotions:
Most pain in MS can be treated. But not all pain a person with MS has is due to MS. Whatever the source, pain is a complex problem that should not be ignored. Many factors may contribute, including fear and worry. A multidisciplinary pain clinic may be indicated for chronic disabling pain, where medication in combination with alternative therapies, such as biofeedback, hypnosis, yoga, meditation, or acupuncture may be used. Self-help may play an important role in pain control, for people who stay active and maintain positive attitudes are often able to reduce the impact of pain on their quality of life.

Chapters of an MS Society in your country may be able to refer callers to area pain clinics or specialists.

Courtesy of:

The MS Information Sourcebook, produced by the USA National MS Society.

Helpful Organizations

Trigeminal Neuralgia Association (TNA) 2801 SW Archer Road Gainsesville , FL 32608 Phone: 1-800-923-3608 or (352) 376-9955 Email: tnanational@tna-support.org Web site: http://www.tna-support.org/

American Chronic Pain Association P.O. Box 850 Rocklin , CA 95677 Phone: 1-800-533-3231 Email: ACPA@pacbell.net Web site: http://www.theacpa.org/

National Chronic Pain Outreach Association (NCPOA) P.O. Box 274 Millboro, VA 24460 Phone: (540) 862-9437 Email: ncpoa@cfw.com Web site : http://www.chronicpain.org/

Mayday Fund (for pain research) c/o SPG 136 West 21 st Street , 6 th fl. New York , NY 10011 Phone: (212) 366-6970 Email: (Mayday Pain Porject) info@painandhealth.org Web site: http://www.painandhealth.org/

American Pain Foundation 201 North Charles Street, Suite 710 Baltimore , MD 21201 Phone: 1-888-615-PAIN (7246) or (410) 783-7292 Email: info@painfoundation.org Web site: http://www.painfoundation.org/

National Foundation for the Treatment of Pain P.O. Box 70045 Houston , TX 77270 Phone: (713) 862-9332 Email: mailto:margordon@paincare.org Web site: http://www.paincare.org/

For information on other neurological disorders or research programs funded by the USA National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN P.O. Box 5801 Bethesda , MD 20824 Phone:1-800-352-9424 or (301) 496-5751 Web site: http://www.ninds.nih.gov/

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