Pain is not a significant problem for all patients with MS, but more than half will, from time to time, experience some type of pain or discomfort. Many experience chronic pain, and women are more likely than men to have pain with MS. Pain that accompanies MS is different from pain that comes from infection or injury. MS-related pain is neurogenic -- that is, it results from an abnormal flow of nerve impulses in the central nervous system. All of the various kinds of pain experienced with MS can be reduced or alleviated with medication or other treatments.

It is important to remember that types and levels of pain are not related to the severity or progression of MS.

Muscle spasms. Opposing muscles are designed to work in cooperation, with one muscle contracting while the other relaxes. Spasticity causes both opposing muscles to contract or relax at the same time. This can cause painful muscles spasms. Cramping can also occur if the patient's water intake is out of proportion with the body's sodium and potassium.

Ways to help relieve or prevent muscle spasms:

Don't become immobile -- frequent movement decreases the severity of cramps and spasms.

Balance water intake with sodium and potassium.

Use massage for comfort and relaxation.

Do stretching exercises twice a day.

Take over-the-counter pain relievers like aspirin or acetaminophen

Talk with a physician about prescription medications like baclofen (Lioresal®) or tizanidine (Zanaflex®).

Keep a board at the foot of the bed and press the ball of the foot against it when cramps begin.

Muscle, joint or back pain. Several things can cause muscle, joint or back pain. Spasticity, which results from MS itself, is one cause. Other causes, which are secondary to the disease, may be easier to remedy. Here are some of these secondary causes, along with suggestions for alleviating discomfort:

Balance or gait problems. When there are problems related to walking, people may overcompensate in ways that strain muscles and joints.

Incorrect use of mobility aids. Walkers, wheelchairs or other assistive devices, if improperly used, can put pressure on joints and cause overuse of certain muscles.

Immobility. Sitting or lying in the same position too long puts pressure on the tailbone and hipbone area, causing pain. Keeping limbs in the same position too long can cause muscle pain when the position is finally changed.

Ways to help relieve or prevent muscle, back and joint pain:

Change positions often when sitting or lying down.

Sleep on a waterbed.

Work with a physical therapist to address posture and gait problems, or to get help in using assistive devices correctly.

Apply moist, moderate heat to painful areas.

Use massage or ultrasound.

Take over-the-counter pain relievers like aspirin or acetaminophen before pain becomes significant

Dysesthesias. Dysesthesias are sensations of burning or aching in the arms or legs, or pain that may girdle around the trunk. Dysesthesias can be acute or chronic. As with most symptoms of MS, dysesthesias occur because of improper conduction of nerve impulses in the central nervous system.

Ways to help relieve dysesthesias:

Place warm compresses on the skin to help change sensations of pain to sensations of warmth.

Wear a pressure stocking to help change sensations of pain to sensations of pressure.

Talk with a physician about a prescription for Elavil or another antidepressant drug. (These help the central nervous system handle pain differently).

Take over-the-counter pain relievers like aspirin or acetaminophen before pain becomes significant.

L'hermitte's sign. L'hermitte's sign is an electrical shock-like sensation that occurs when the neck is flexed forward. The sensation travels down the spine and into the arms or legs. A majority of patients don't experience this symptom. While it signifies that spinal cord damage has taken place in the neck region, it is not a conclusive indication of MS. L'hermitte's sign is a disturbing sensation, but it is not serious. It is usually not treated with medication since it comes and goes so quickly. A soft collar that restricts neck flexion may be the most helpful treatment.

"Regular" Pain. Like everyone else, people with MS can experience pain that is unrelated to MS. Tension or migraine headaches, backaches, and other conditions or illnesses are examples. It is important to describe and discuss painful symptoms with a physician who can determine whether the cause is MS or something else. An accurate diagnosis is necessary to successfully treat the problem.

Trigeminal Neuralgia (Tic Douloureux). Fewer than 5 percent of people with MS experience a very painful condition called trigeminal neuralgia. This disorder, also known as tic douloureux, also occurs in people who do not have multiple sclerosis. Trigeminal neuralgia is a disorder of the fifth cranial nerve, the trigeminal nerve. The trigeminal nerve communicates the sensory messages of touch, pain, pressure and temperature from the regions served by its branches: the lips, upper and lower jaws, nose, forehead, scalp and eyes.

Trigeminal neuralgia causes intense pain, which may be experienced as electric shock-like, stabbing sensations, typically on just one side of the face. The attacks may be stimulated by normal activities like brushing the teeth, putting on makeup, chewing, swallowing, or talking. Even a slight breeze or a light touch to the face can trigger an attack. The pain can be agonizing, usually lasting only a few seconds, but coming and going many times a day. Trigeminal neuralgia can persist for days, weeks or even months before disappearing for many months or years.

Trigeminal neuralgia is more common in women than in men and does not often occur in people younger than 50, unless they have MS. However, cases have been reported even in very young children. Trigeminal neuralgia is often mistaken for dental pain. It can be one of the very first symptoms of MS.

Relieving Trigeminal Neuralgia

No tests are needed to diagnosis trigeminal neuralgia. Following a physical examination, anticonvulsant medications such as Tegretol, Dilantin or Neurontin may be prescribed. Baclofen, a muscle relaxant, or antidepressant drugs are sometimes also used. These medications will often be tapered in dosage and discontinued after a period of weeks or months.

If medications are not effective, a surgical procedure called rhizotomy can be performed to sever the nerve roots that allow sensation. Alternative approaches, such as acupuncture, meditation, or chiropractic care may be effective for some patients.

Emotions affect a person's perception of pain and influence one's ability to tolerate pain. Fear, worry, or an excessive focus on pain can magnify pain until it plays a disproportionate role in our lives. To keep pain in perspective, we must nurture our overall emotional well-being.

When emotional and social needs are well met, pain may not seem as predominant. A combined strategy, consisting of self-help, support from others, and pain management therapies may be the best approach. Alternative therapies like biofeedback, acupuncture, yoga, or hypnosis can be added to more mainstream approaches such as medication, support groups and psychotherapy. Staying socially active and getting involved in helping others through church or community groups can also help keep pain in perspective.

References

First published October 1, 1999
Last updated May 5, 2003
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

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