Posted by: Thixia | March 19, 2008

MS-Related Pain

In the past MS was viewed as a painless condition but now thankfully people have woken up to the fact that pain can be very much part and parcel of MS 

In fact it is now thought that 50% of people with MS experience MS-related pain or discomfort at some point or other during their lifetime.    

This MS related pain, generally falls into one of three categories:   

1.  Musculoskeletal pain 

This is generally due to muscular weakness, spasticity, and imbalance caused by MS.  It is most often seen in the hips, legs, and arms and most often occurs as a result of immobility which causes muscle wastage, stiffness, and inflexibility.  This is where the value of exercise comes, in spite of the MS symptoms.  

 It is vitally important to keep these muscles, tendons, and ligaments strong and as flexible as possible to avoid added pain and discomfort, which can occur as a result of neglect.  When MS restricts movement, and increases tone and spasticity you have to work doubly hard to keep those muscles strong.   

Back pain may occur due to improper seating or incorrect posture while walking.  This is called compensation, the body moving in ways to compensate for weakness or lack of balance.  Unfortunately the result is often tight muscle and this Musculoskeletal pain.  

This pain and discomfort needs to be addressed at its cause i.e. through intense Physiotherapy to loosen up these painfully tight muscles and also encourage proper posture.   

Muscular spasms or cramps are a common symptom of MS and can be very painful.  Leg spasms, for example, often occur during sleep and can cause extreme discomfort and interrupt sleep.  There are various drugs available which can alleviate spasticity and painful muscle spasms, so it is best to consult your neurologist about such symptoms.  Many people find cannabis or Sativex effective in reducing muscular spasms and alleviating the pain.  Often intense physio is also required to loosen the muscle tightness caused by these involuntary muscle spasms.  Generally the cause of musculoskeletal pain is assessed and addressed before the use of painkillers is considered as a treatment.   

 2.  Paroxysmal pains 

This is seen in 5-10% of people with MS.  The most characteristic is the facial pain of tic doloreux (trigeminal neuralgia), which usually responds to carbamazepine (tegretol).  

L’hermittes sign is a stabbing, electric-shock-like sensation running from the back of the head down the spine, brought on by bending the neck forward.  Medication is of little use because this pain is instantaneous and brief.  A soft collar to limit neck flexion may be prescribed.    

3.  Chronic neurogenic pain 

This is the most common, distressing and intractable of the pain syndromes in MS.  This pain is described as constant, boring, burning, or tingling intensely.  It usually occurs in the legs.   

Paraesthesias include pins and needles; tingling; shivering; burning pains; feelings of pressure; and areas of skin with heightened sensitivity to touch.  The pains associated with these can be aching, throbbing, stabbing, shooting, gnawing, tingling, tightness, and numbness.   

Dysesthesias include burning, aching, or girdling around the body.  These are neurologic in origin and are sometimes treated with antidepressants.  

 Optic Neuritis (ON) is a common first symptom of MS.  Pain commonly occurs or is made worse with eye movement.  The pain with ON usually resolves in 7-10 days.    

Treatment of pain in MS Exercise and physical therapy may help to decrease spasticity and soreness of muscles.  Unfortunately people with MS may not always have the ability or endurance to do sufficient aerobic exercise.  Regular stretching exercises help flexor spasms.   

Non-drug Treatments include, relaxation techniques such as progressive relaxation, meditation, and deep breathing can contribute to the management of chronic pain.   

Other techniques which may help pain include massage, ultrasound, chiropractic treatments, hydrotherapy, acupuncture, transcutaneous nerve stimulation (TENS), moist heat, and ice.    

Drugs

 Pain from damage to the nerves in the central nervous system in MS is normally not relieved by the usual analgesics (e.g.  aspirin).  Drugs that treat seizures (e.g.  carbamazepine) and antidepressants (e.g.  amitriptyline) are often effective in these cases.   

Treatment for spasms include baclofen, tizanidine, gabapentin, and ibuprofen.    

Conclusion 

Pain in MS is a hidden symptom, but one which can be persistent.  Pain can cause much long-term distress and impact severely on quality of life.  Self-help may play an important role in pain control as people who stay active and maintain positive attitudes are often able to reduce the impact of pain on their quality of life.     

Ref: Multiple Sclerosis International Federation, “Pain in MS”.      

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