Pain in MS

Multiple Sclerosis was considered for many years to be a painless disease. The current view is that approximately 50% of people with MS experience pain or discomfort at some time during the course of their disease. When severe, pain in MS can be among the most difficult of symptoms to treat. Common aches and pains that affect the general population are probably more frequent in people with MS than in non-affected individuals. Headaches are not generally regarded as caused by MS.

Some authors describe pain in MS as either chronic or acute. Steady and achy type pain often results because muscles become fatigued and stretched when they are used to compensate for muscles that have been weakened by MS. People with MS may also experience more stabbing type pain which results from faulty nerve signals emanating from the nerves in MS lesions in the brain and spinal cord.

Alternatively one can describe three types of pain which occur as secondary to MS:

1. Musculoskeletal pain
2. Paroxysmal pain
3. Chronic neurogenic pain

1. Musculoskeletal pain can be due to muscular weakness, spasticity, and imbalance. It is most often seen in the hips, legs and arms and particularly when muscles, tendons and ligaments remain immobile for some time. Back pain may occur due to improper seating or incorrect posture while walking. Contractures associated with weakness and spasticity can be painful. Muscular spasms or cramps (called flexor spasms) can be severe and discomfiting. Leg spasms, for example, often occur during sleep.

Treatment of musculoskeletal pain should aim to correct the cause before consideration of analgesics

2. Paroxysmal pains are 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.

Lhermittes sign is a stabbing, electric-shock-like sensation running from the back of the head down the spin 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 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:

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, and ibuprofen.

Conclusion

Pain is 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, for people who stay active and maintain positive attitudes are often able to reduce the impact of pain on their quality of life.

References

Sibley WA.
Therapeutic Claims in Multiple Sclerosis
4th Edition; 1996. Demos Vermande, New York

Paty DW & Ebers GC.
Multiple Sclerosis
1998 FA Davis Company, Philadelphia

Kraft GH & Catanzaro M.
Living with Multiple Sclerosis – A Wellness Approach
2nd Edition; 2000. Demos Medical Publishing, New York

Benz C.
Coping with Multiple Sclerosis
1996 Vermilion, London