Pain

Pain is a common symptom in MS, with up to two-thirds of people with MS reporting pain in worldwide studies. Those who experience pain may find it affects their daily life activities, such as work and 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 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 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 musculoskeletal, paroxysmal or chronic neurogenic.

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 flex or spasms) can be severe and discomfiting. Leg spasms, for example, often occur during sleep.

Paroxysmal pains are seen in between five and ten per cent of people with MS. The most characteristic is the facial pain of trigeminal neuralgia, which usually responds to anticonvulsants such as carbamazepine, oxcarbazepine and lamotrigine.

Lhermittes is indicated by a stabbing, electric-shock-like sensation running from the back of the head down the spine brought on by bending the neck forward. Medication is of little use because this pain is instantaneous and brief, but anticonvulsants may be used to prevent the pain, or a soft collar to limit neck flexion.

Neurogenic pain is the most common and distressing of the pain syndromes in MS. This pain is described as constant, boring, burning or tingling intensely. It often occurs in the legs.

Paraesthesia types 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.

Dysesthesia types 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 between seven and ten days.

Treatment of pain in MS

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

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

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

Conclusion

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

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Aversa, Italy, 03/2012. Like many people with MS, Stefania Salzillo finds it difficult to cope with the daily injections of Interferon-b. Her boyfriend, Ernesto Lodice, helps out providing both practical and emotional support. But access to medication was relatively quick: she received her first prescription within two months of being diagnosed. The cost of DMDs in Italy is 100% covered by the national health plan. Credit: Walter Astrada. Published on this website by kind permission of the European Multiple Sclerosis Platform.

Minsk, Belarus, 10/2011. Alena Kleshchanka (51) has spent most of the past seven years organising her days around Nicolai’s needs. Blind and virtually paralysed from the neck down, Nicolai is mentally sharp. While the physical burden of care is heavy for Alena, the couple continue to share a loving relationship. Credit: Walter Astrada. Published on this website by kind permission of the European Multiple Sclerosis Platform.