Pain

Pain is a common symptom in MS, with up to two-thirds of people withMS reporting pain in worldwide studies. Those who experiencepain may find it effects their daily life activities, such as workand recreation, and their mood and enjoyment of life.

Why does pain occur in MS and what are the common types?

Steady and achy types of pain in MS may be a result of muscles become fatigued and stretched when they are used to compensate for musclesthat have been weakened by MS. People with MS may also experience morestabbing type pain which results from faulty nerve signals emanatingfrom the nerves due to MS lesions in the brain and spinal cord.

The most common pain syndromes experienced by people with MS include:

  • headache (seen more in MS than the general population)
  • continuous burning pain in the extremities
  • back pain
  • painful tonic spasms (a cramping, pulling pain)

Experts usually describe pain caused by MS as either musculoskeletal pain, paroxysmal pain or chronic neurogenic pain.

Musculoskeletal pain can be due to muscular weakness, spasticityand imbalance. It is most often seen in the hips, legs and arms andparticularly when muscles, tendons and ligaments remain immobile forsome time. Back pain may occur due to improper seating or incorrectposture while walking. Contractures associated with weakness andspasticity can be painful. Muscular spasms or cramps (called flexorspasms) can be severe and discomfiting. Leg spasms, for example, oftenoccur during sleep.

Paroxysmal pains are seen in 5-10% of people with MS. The mostcharacteristic is the facial pain of trigeminal neuralgia, which usuallyresponds to carbamazepine. Lhermittes sign is a stabbing,electric-shock-like sensation running from the back of the head down thespin brought on by bending the neck forward. Medication is of littleuse because this pain is instantaneous and brief.

Neurogenic pain is the most common and distressing of the painsyndromes in MS. This pain is described as constant, boring, burning ortingling intensely. It often occurs in the legs. Paraesthesia typesinclude pins and needles, tingling, shivering, burning pains, feelingsof pressure, and areas of skin with heightened sensitivity to touch. Thepains associated with these can be aching, throbbing, stabbing,shooting, gnawing, tingling, tightness and numbness. Dysesthesia typesinclude burning, aching or girdling around the body. These areneurologic in origin and are sometimes treated with antidepressants.

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

Treatment of pain in MS

Exercise and physical therapy may help to decrease spasticity andsoreness of muscles. Regular stretching exercises can help flexorspasms.Relaxation techniques such as progressive relaxation, meditation anddeep breathing can contribute to the management of chronic pain.

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

Pain from damage to the nerves in the central nervous system in MS isnormally not relieved by the usual analgesics (such as aspirin). Drugsthat treat seizures (for example carbamazepine) and antidepressants(such as amitriptyline) are often effective in these cases. Treatmentfor spasms can include baclofen, tizanidine and ibuprofen.

Conclusion

Pain is MS is a hidden symptom, but one which can be persistent. Paincan cause long-term distress and impact severely on quality of life.Self-help may play an important role in pain control; people who stayactive and maintain positive attitudes seem more able to reduce theimpact of pain on their quality of life.

Further information

Read more about MS pain in MS in focus - pain.