Posted by: Thixia | March 13, 2008

MS Pain Management 2 of 7

What do you mean by pain? ‘

Being able to explain your pain also helps family, friends and carers understand this ‘invisible symptom.’ Sensory symptoms may change, so that they feel more painful sometimes and less so at other times. A ‘tingling, pins-and-needles’ sensation in the hand, for example, might sometimes be a niggling inconvenience, or make holding things difficult. At other times, it may be very painful. Describing these changes can also help other people to understand the issue and work with you to find ways to treat and manage the symptom. MS can cause pain either directly, due to nerve damage, or indirectly, due to MS symptoms. Pain may also be a side effect of drugs. But having MS does not rule out the possibility of experiencing pain due to other health conditions or accidents, just like anyone else. Furthermore, if you experience pain it could be because of one of these factors, or a combination of several.

Neuropathic pain and sensory symptoms

‘Neuropathic pain’ (sometimes called ‘neurogenic pain’) is caused by MS nerve damage in the brain and spinal cord. Normally, signals from the brain travel along the spine to the rest of the body via insulated nerve fibres. MS damages this insulation, called ‘myelin’, stripping it away from the nerve fibre so that signals can become distorted and ‘short-circuit’ between nerve fibres. MS also causes increased nervous activity in the spinal cord and nerve fibres can become hyper-sensitive. The exact way that nerve damage causes pain is not yet fully understood. But such nerve damage might cause a range of sensations, from minor irritations to intense sharp or burning pains.

Musculoskeletal pain

‘Musculoskeletal pain’ is the pain in muscles and joints that comes from living with the stresses and strains MS places on the body. For example, difficulties with balance, fatigue or muscle weakness could lead to problems with posture, putting a strain on joints, ligaments or other muscles. If you are less mobile than you once were, this can also take its toll on muscles and joints and again may lead to pain. MS can also cause painful muscle spasms and stiffness (often known as ‘spasticity’). What causes pain in MS?

Internal symptoms

Pain might also be caused by internal symptoms, such as a bladder infection, or problems with the bowel. With proper medical assessment, these problems can be identified and treated, rather than being concealed by painkillers.

Side effects of drug treatments

It is worth remembering that certain drug treatments can have painful side effects. Some people taking beta interferon, for example, experience headaches and flu-like symptoms such as aching muscles, particularly in the first few months of taking the drug. Ibuprofen and paracetamol can both help control these side effects. Some people taking Copaxone (glatiramer acetate) notice an uncomfortable feeling of tightness or pain around the chest. With all drug treatments, if you have unpleasant side effects, discuss these with your doctor or MS nurse, who may be able to find alternatives or ways to manage them.

Other health conditions

If you experience a new pain, it is important to consult a health care professional. Do not assume it is caused by your MS. There could be another cause that needs treating, quite separate from your MS. MS pains are sometimes described by their medical names, or categorised according to whether they are chronic or acute, neuropathic, or musculoskeletal. Not everybody with MS experiences pain and it is unlikely that anyone will experience all of the types of pain listed in the tables below. However, you may find that at different times you have pain that fits one or more of the various definitions.

Chronic (long-lasting, continuing) Neuropathic

• Dysesthetic extremity pain: tingling, numbness, shivering, burning, pins-and-needles or ‘creeping pain’. These sensations might come out of the blue or be triggered by super-sensitive skin, for example, where just the lightest of touches feels unpleasant or painful.
• Girdling, banding or squeezing: ‘a tight band’, or constricting pain, usually around the trunk of the body.

Compliments of:
UK Multiple Sclerosis Society


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