Posted by: february13 | March 17, 2008

MS Pain Management 4 of 7

Triggers    

Some people find there are things that set off painful sensations, or make them feel worse. For example, heat and cold can make muscle pains worse and flexing the neck sometimes brings on the sharp, shooting pain of L’Hermitte’s sign. Recognising triggers like this can help determine the cause of a pain and may also help to manage it. It is therefore worth mentioning any triggers during pain assessments.  

 

Addressing the emotional side of pain 

  

Pain is more than a physical symptom. Circumstances and emotions can affect how you cope with it. Some people say they find temporary relief when they are completely involved in an enjoyable activity, drawing their attention away from the pain. Talking therapies, such as counselling, psychotherapy, and cognitive behaviour therapy (CBT) may help some people to reduce the impact of pain. 

  

Anxiety, low mood and depression are relatively common in MS and can make dealing with pain more difficult. If you feel your mood is low, talk to your doctor or MS nurse. There are many options for treating anxiety and depression, and successful treatment may help your pain. For more information about talking therapies, anxiety and depression, see the MS Society publication Mood, depression and emotions.  The relationship between sensations and emotions works the other way too.

  

If you experience pain, you may find it harder to concentrate, relax, or carry out daily tasks that would otherwise be simple to do, especially if pain is repetitive or long-lasting. Finding ways to minimise your pain might also have benefits for beating stress and anxiety.  ‘Some people find there are things that set off painful sensations, or make them feel worse.’  Your doctor or MS nurse might refer you to a physiotherapist to help manage musculoskeletal pain.  

  

Physiotherapy covers a range of treatments, including exercise plans, stretching, manipulation, massage, and water-based exercises (called hydrotherapy).  Acupuncture is also sometimes available through physiotherapy departments.   Pain can make movement or exercise difficult. Where that is the case, physiotherapy can be particularly useful as it can help prevent further problems, such as muscle wasting and joint stiffness, which may otherwise build up over time.  

 

An occupational therapist can help manage both neuropathic and musculoskeletal pain. They assess the spaces you live and work in, making sure they are as easy to use as possible. They can also help ensure your posture and the way you carry out tasks do not add to any pain you already have and help you avoid triggers that make your pain worse. At home, there could be adjustments to the layout of a kitchen or bathroom that save you from bending or twisting unnecessarily, reducing the strain on your muscles and joints.   

If you are working, you may find there are adjustments that help with managing pain. You may need to ask your employer to make some changes – perhaps more flexible hours would help, or adjustments to your workspace. Under the Disability Discrimination Act, most employers are legally obliged to make ‘reasonable adjustments’ to allow you to carry on working.  A Disability Employment Adviser (DEA) from your local Job Centre Plus can explain your rights and responsibilities and help you get the adjustments you need.    

Drugs alone are not usually the answer, partly because their usefulness has to be balanced against side effects. However, they are often an effective part of managing pain.

Drug treatments for pain vary greatly and there are a number of different drugs available. It can take some time for the effective dose of drugs to build up, and it can take a while to find the right drug, or combination of drugs, and doses for you.  These drugs usually come as a tablet, but other preparations are available if, for instance, someone has difficulty swallowing.  Many of the drugs used to treat MS pain are licensed for other conditions, like epilepsy or depression. If your doctor prescribes these drugs, it is not necessarily because they think you have these other conditions, it is because they can help to combat certain kinds of pain. The exact way these drugs work against pain is not clear.

However, both anticonvulsants and antidepressants appear to alter electrical activity in the nerves of the brain or spinal cord, affecting how pain is experienced.  Because the underlying causes of pain varies, a drug that works for one sensation may have no effect in controlling another. Different drugs are prescribed according to what sort of pain is being targeted.      

Drugs for neuropathic pain: Anticonvulsants  

Some of the most commonly used anticonvulsants are carbamazepine, gabapentin, lamotrigine, and phenytoin. These help some people control the facial pain of trigeminal neuralgia and other acute neuropathic pains. Some may also give some relief from ‘burning’, ‘throbbing’, or ‘pins-and-needles’ pains.  Possible side effects vary between the different drugs, but can include a skin rash, dizziness, blurred vision and drowsiness. A recent study comparing three of these drugs suggested that gabapentin and lamotrigine may cause fewer side effects than carbamazepine. 

   Antidepressants   

Amitriptyline is widely used. It belongs to a group of drugs called ‘tricyclic antidepressants’ and you may be prescribed other similar antidepressants from this group. These can be useful for treating certain types of longlasting pain, such as when skin becomes painfully sensitive to even the lightest touch.  Possible side effects from tricyclic antidepressants include dry mouth, constipation and blurred vision.   

Steroids   

Steroids are often used to speed up recovery from a relapse, by reducing inflammation in the central nervous system. A relapse might involve painful symptoms, such as trigeminal neuralgia or optic neuritis, so by treating the relapse the pain may be resolved.    

Drugs for musculoskeletal pain:

Analgesic painkillers   

Drugs like paracetamol, aspirin, ibuprofen, codeine, and morphine can help control non-neuropathic pain. However, these traditional painkillers should not be used without having first tried to assess, with a health care professional, what is causing the pain. Ignoring the underlying problem can make the pain worse in the long run. Having assessed your pain, your doctor may recommend you use these traditional painkillers alongside treatments that address the root cause of the pain.    

Antidepressants   

Tricyclic antidepressants, such as amitriptyline can also be useful for treating musculoskeletal pain. However, just like analgesics, they should not be used without first investigating and treating the cause of the pain.     

Compliments of:UK Multiple Sclerosis Society 

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Responses

  1. I was diagnosed with ms in 2005. I am currently recieving a steroid treatment at day health for 3 days every 3 months My Doctor is Peter Wade. My pain is dull but constant. What is available. I do not want to take pills. I was told of medical massage or some kind of water treatment I belong to a ms support group based out of Waterbury.

  2. Have you tried any of the injectable disease modifying treatments? They really to help.

    There are certain dangers involved in taking steroid treatment for a prolonged period of time.


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