From The MS Information Sourcebook, produced by the National MS Society.
Pain syndromes are not uncommon in MS. In one study, 55% of the people studied had what is called "clinically significant pain" at some time during the course of a lifetime with MS. Almost half (48%) were troubled by chronic pain. This study suggested that factors such as age at onset, length of time with MS, or degree of disability played no part in distinguishing the people with pain from the people who were pain free. The study also indicated that twice as many women as men experienced pain as part of their MS.
Several Sources and Types of Pain in MS
Acute Pain Burning, Aching, or "Girdling" around the Body are all neurologic in origin. The technical name for them is dysesthesias . These pains are often treated with the anticonvulsant medication gabapentin (Neurontin®). Dysesthesias may also be treated with an antidepressant such as amitriptyline (Elavil® ), which modifies how the central nervous system reacts to pain. Other treatments include wearing a pressure stocking or glove, which can convert the sensation of pain to one of pressure; warm compresses to the skin, which may convert the sensation of pain to one of warmth; and over-the-counter acetaminophen (Tylenol® and others) which may be taken daily, under a physician's supervision.
Trigeminal neuralgia is a stabbing pain in the face. It can occur as an initial symptom of MS. While it can be confused with dental pain, this pain is neuropathic (caused by damage to the trigeminal nerve) in origin. It can usually be treated successfully with medications such as the anticonvulsants carbamazepine (Tegretol® ) or phenytoin (Dilantin®).
Lhermitte's sign is a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward. Medications, including anticonvulsants, may be used to prevent the pain, or a soft collar may be used to limit neck flexion.
Duloxetine hydrochloride (Cymbalta®) was approved by the U.S. Food and Drug Administration (FDA) in 2004 for the treatment of depression and the treatment of pain associated with diabetic peripheral neuropathy. Cymbalta® belongs to the group of medications known as selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Although not specifically approved for use in MS, its effectiveness in diabetic neuropathy makes it a suitable candidate for the treatment of neuropathic pain in MS, and MS specialists physicians consider it a good treatment option for people with MS.
- Chronic Pain
Burning, Aching, Prickling, or "Pin and Needles" may be chronic rather than acute. The treatments are the same as for the acute dysesthesias described above.
Pain of Spasticity has its own subcategories. Muscle Spasms or Cramps, called flexor spasms, may occur. Treatments include medication with baclofen (Lioresal®) or tizanidine (Zanaflex®), ibuprofen, or other prescription strength anti-inflammatory agents. Treatment also includes regular stretching exercises and balancing water intake with adequate sodium and potassium, as shortages in either of these can cause muscle cramps. Tightness and Aching in Joints is another manifestation of spasticity, and generally responds well to the treatment described above.
Back and Other Musculoskeletal Pain in MS can have many causes, including spasticity. Pressure on the body caused by immobility, or incorrect use of mobility aids, or the struggle to compensate for gait and balance problems may all contribute. An evaluation to pinpoint the source of the pain is essential. Treatments may include heat, massage, ultrasound, physical therapy, and treatment for spasticity.
Pain and the Emotions
Most pain in MS can be treated. But not all pain a person with MS has is due to MS. Whatever the source, pain is a complex problem that should not be ignored. Many factors may contribute, including fear and worry. A multidisciplinary pain clinic may be indicated for chronic disabling pain, where medication in combination with alternative therapies, such as biofeedback, hypnosis, yoga, meditation, or acupuncture may be used. 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.
Chapters of the National MS Society may be able to refer callers to area pain clinics or specialists.
Trigeminal Neuralgia Association (TNA)
2801 SW Archer Road
Gainsesville , FL 32608
Phone: 1-800-923-3608 or (352) 376-9955
Web site: www.tna-support.org/
American Chronic Pain Association
P.O. Box 850
Rocklin , CA 95677
Web site: www.theacpa.org/
National Chronic Pain Outreach Association (NCPOA)
P.O. Box 274
Millboro, VA 24460
Phone: (540) 862-9437
Web site : www.chronicpain.org/
Mayday Fund (for pain research)
136 West 21 st Street , 6 th fl.
New York , NY 10011
Phone: (212) 366-6970
Email: (Mayday Pain Porject) firstname.lastname@example.org
Web site: www.painandhealth.org/
American Pain Foundation
201 North Charles Street, Suite 710
Baltimore , MD 21201
Phone: 1-888-615-PAIN (7246) or (410) 783-7292
Web site: www.painfoundation.org/
National Foundation for the Treatment of Pain
P.O. Box 70045
Houston , TX 77270
Phone: (713) 862-9332
Web site: www.paincare.org/
For information on other neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
P.O. Box 5801
Bethesda , MD 20824
Phone:1-800-352-9424 or (301) 496-5751
Web site: www.ninds.nih.gov/