Posted by: Thixia | August 17, 2008

MS: Controlling Pain 2 of 2

Taking control of your pain


Everyone has a right to good pain control. Many people with MS live with pain that could be effectively relieved. Sometimes this is because their existing treatment is not working, because they or their health professionals are not aware of all treatment methods, or because they don’t know how to bring up the topic with their doctor. How can you make sure that you get effective pain relief?


Communication is key to successful pain control.


Pain is subjective – it can’t be measured with a blood test or a scan. Plus, the severity and types of pain vary widely between people with MS. This means that your own description of the pain will be a critical tool for the health professionals involved in your care. They will use your own evaluation of the pain to help choose and adjust treatment.


The “PQRST” is a popular way of measuring and describing pain:


  • P = Provoking and palliating factors: What makes the pain better (palliating) or worse (provoking)?
  • Q = Quality: What does the pain feel like? (e.g., burning, stinging, aching, pounding)
  • R = Radiation: Does the pain “move” to other areas of the body?
  • S = Severity: How bad is the pain? Usually you’ll be asked to rate the pain on a scale of zero to 10, with zero being “no pain” and 10 being “the worst pain you can imagine”.
  • T = Time: When did the pain start? Does it come and go? If so, how often to you have pain and how long does it last?

This method helps doctors understand what your pain is like. This will assist them in the next step of pain control, which is identifying the cause of the pain. This is important, since treatment options often depend on what is causing the pain. The doctor will also try to figure out whether the pain is being caused by MS, or by another medical condition (since people with MS can still get other conditions, such as arthritis). Using the PQRST will also help you track your pain over time to see how well treatments are working. Sometimes, it is not possible to completely relieve all pain, and it may be necessary to agree on an “acceptable” level of pain relief to try for.


Depending on the cause of your pain, you will probably need a combination of medication and non-medication treatment options to get effective pain relief. Medication options include:


  • painkillers taken by mouth, such as acetaminophen, ibuprofen, or codeine
  • painkillers given by injection, such as morphine
  • medications taken by mouth for nerve pain, such as amitriptyline and gabapentin
  • medications taken by mouth for spasticity, such as baclofen and tizanidine
  • medications that are applied to the skin, such as capsaicin

Non-medication options include hot or cold packs, physiotherapy, stretching, yoga, or acupuncture.



There is also a mental and emotional side to pain.


Many people also find that doing things they enjoy helps take their mind off of the pain. Meditation, humour, and relaxation techniques can also help with pain relief. It’s also important to have an emotional support network of friends, family, and other people with MS.


If you are not satisfied with your level of pain relief, or if you would like to try another pain control option, speak with your doctor, pharmacist, or nurse. Only you know how the pain feels, so only you can judge whether the pain relief plan is working.


New research into MS pain


Medical research is leading to a better understanding of MS pain and opening up new treatment avenues.


Researchers are putting together a more complete picture of how the body perceives and deals with pain. For example, we now know more about sodium channels, which are “gateways” between the inside and outside of nerve cells. Sodium channels are involved in helping pain signals travel along pathways through the body. If sodium channels are not working properly, inappropriate pain signals may be sent.


Although it was believed that there was only one kind of sodium channel, new studies show there are as many as 10 different kinds. This opens up the possibility of developing new drugs to act on the different sodium channels and help with MS pain. Another interesting area of research is medications that regulate pain by turning genes in nerve cells on or off.


You may have heard about people smoking marijuana to relieve MS pain and symptoms. Is there any evidence that it works, and is it legal? Studies have shown that cannabis oil (which comes from the marijuana plant) and pills of THC (the main active ingredient of marijuana) produce some improvement in pain. However, smoking marijuana is not generally recommended as a medical treatment because it may be even more harmful than smoking cigarettes. But it can be used as a “last resort” for people whose pain cannot be controlled by other means.


In Canada, people with MS can apply for special permission to use marijuana legally for persistent, severe pain related to MS. Your doctor will need to be involved in the process, and you will need to use a government-approved supply of marijuana. To find out more about MS pain control options or research, speak with your doctor or pharmacist.






The contents of this site are for informational purposes only and are meant to be discussed with your physician or other qualified health care professional before being acted on. Never disregard any advice given to you by your doctor or other qualified health care professional. Always seek the advice of a physician or other licensed health care professional regarding any questions you have about your medical condition(s)




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