Symptom Awareness
Understanding and Managing MS Pain
More than 50 percent of individuals with MS identify pain as a significant symptom.. For many years, the medical community did not support the idea that pain could be caused by the effects of MS, but physicians today recognize that pain is a common symptom.
MS pain may be divided into two groups. The first type of pain is directly caused by damage to the myelin and nerves within the central nervous system (CNS), which consists of the brain and spinal cord. This type of neurogenic pain is often referred to as primary, since the sensation tends to be more intense. The second type of pain is not a direct result of myelin and nerve damage, but rather a reaction to some aspect of MS. This is frequently referred to as neuromuscular or musculo-skeletal pain, while some categorize this as secondary pain.
Neurogenic Pain
The heart of the problem with this type of pain lies within the nerves of the CNS that are either inflamed or are malfunctioning after the protective layer of myelin has been damaged. Nerve impulses may go off-track and spread to adjacent damaged nerve fibers, or nerve cells may become over stimulated and misfire. This type of "nerve excitability" is irritating to the nerve cells within the brain and spinal cord, often causing sudden and sharp pain. The sensation can be lightening-like, or it can be a burning, tingling, or tightening feeling.
Examples of neurogenic pain includes: trigeminal neuralgia, a sharp facial pain brought on by a light touch or movement; L'Hermitte's sign, a shock-like sensation down the spine and legs when the neck is flexed; severe spasms and spasticity; dysesthetic pain, a burning, tingling, and tightening sensation, usually in the legs and arms but sometimes in the body; and optic neuritis, causing shooting pains in the eye.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen won't work on this type of pain. The over-stimulated nerves need to be calmed, and this may best be accomplished through anti-epileptic drugs such as Neurontin® (gabapentin), Tegretol® (carbamazepine), and Dilantin® (phenytoin). Tricyclic antidepressants, such as Tofranil® (imipramine) may also be used, and anti-spasticity drugs, including Lioresal® (baclofen) and Zanaflex® (tizantidine), can treat painful spasticity and spasms. Zostrix® (capsaicin topical analgesic) may help reduce the dysesthetic sensations of burning and tingling. Optic neuritis is often treated with steroids to reduce the inflammation of the optic nerve.
Non-pharmaceutical strategies may help to reduce the perceived severity of the pain. Biofeedback, self-hypnosis, visualization, and other methods that develop a mind-body connection may assist an individual in lowering his or her degree of pain.
Neuromuscular Pain
This type of pain is usually less intense but can be long-lasting. For instance, weakness on one side of the body will cause someone to favor the other side and develop stiff joints; muscles get twisted and this puts the body at an imbalance, frequently leading to muscle and joint pain. The same is true for spasticity and spasms, as well as poor posture, with pain often occurring in the lower back. Weakness in the neck may lead to headaches, while medications can sometimes cause painful side effects such injection-site reactions and steroid-induced osteoporosis.
Unlike neurogenic pain, neuromuscular pain may respond to NSAIDs, which includes ibuprofen (Advil® and Motrin®). Tylenol® (acetaminophen) may help with this type of discomfort too. Antidepressants are sometimes effective and their function is two-fold: they may help shift the perception of pain, while also elevating one's mood, which may be initially brought down from long-lasting pain. Anti-spasticity medications may be used if spasticity and/or spasms are contributing to one's discomfort.
Non-pharmaceutical approaches include the same mind-body strategies listed in the previous section, as well as acupuncture, massage, tai chi, yoga, meditation, hydrotherapy, and physical therapy, among others. A physical therapist experienced with MS can be particularly useful in returning balance and good posture back to one's movement.
Warm compresses can sometimes loosen a tight muscle or reduce lower back pain, while an ice pack is normally prescribed for a recent muscle injury or injection-site reactions. MS experts caution their patients about chiropractic care as it can potentially aggravate the nerves of the back and neck. If back pain is severe, tests should be done to see if a pinched nerve, slipped disc, or other structural problem is at fault.
Putting It All Together
Pain with MS is a complex problem involving many issues. Keeping a "pain diary" and verbalizing precisely how the pain feels, where and when it occurs, and what factors increase, decrease, or change the pain, are crucial to an accurate diagnosis and optimum treatment plan. Seeing a medical professional is the first step toward getting relief, and if pain continues despite treatment, clients should ask to be referred to a pain center, specifically one that is experienced with treating individuals with MS and can offer a team approach.
Pain affects the entire individual and can interfere with mood, relationships, employment, activities, and quality of life. Depression is not uncommon for individuals with MS, particularly if they are experiencing pain. Individuals should also work toward fulfilling personal interests such as being around pets, music, and art, to help lift the spirit and take the mind off pain.
For more information, please refer to the pain section in MSAA's booklet entitled Managing Symptoms. This may be found under "publications" on MSAA's website at www.msaa.com, or a copy of the section may be requested by calling (800) 532-7667. Callers may also speak with a consultant for assistance, or request a copy of MSAA's pain article from the winter 2002 issue of The Motivator.
