MS Symptom: Pain

Reviewed by: HU Medical Review Board | Last reviewed: May 2021.

Just as physical signals to move the body can be affected by MS, sensation signals can be affected, too. In fact, it is common for people with MS to experience pain. However, pain severity can vary greatly. The way 1 person describes and feels pain is not the same way as the next person.

Pain can be caused by many different things, often at the same time. This is what makes understanding pain so challenging. Experts have suggested that anywhere from 25 percent to 80 percent or more of those with MS experience significant pain.1-3 Pain in MS can be acute (short-term), especially during flares. However, pain in MS can also be chronic (long-term). In either case, pain can severely impact quality of life and mental health.

Why does pain occur in MS?

In MS, the body mistakenly attacks its own nerves. This can lead to damage and inflammation that interferes with pain signals. In some cases, this pain is directly related to nerve damage caused by MS. In other cases, pain has another cause. This could include pain from changes in posture after years of MS.

Types of primary pain

Primary pain is thought to be directly related to MS damage. For example, optic neuritis is eye pain related to damage of the optic (vision) nerve from MS. Several types of primary pain in MS include:1-3

  • Trigeminal neuralgia (TN): This occurs when MS damages the nerves that send signals to the face. Specifically, a nerve called the trigeminal nerve. People with TN experience sharp sensations that feel like electricity. These can be very painful and triggered by even the lightest facial touch. People with TN may have trouble eating, shaving, or brushing their teeth.
  • Lhermitte’s sign: This term also refers to electric shock-like sensations. However, these occur when bending the neck forward. The pain travels down a person’s back and into their limbs. These sensations are quick but less intense than in TN.
  • Burning limb pain: This type of pain is typically described as burning, aching, or tingling of a limb. It often happens at night. People with this type of pain may also have other changes in sensation. This includes pain with touch or feeling a sensation of coldness. It has also been called dysaesthetic extremity pain.
  • Optic neuritis: People with optic neuritis experience pain in their eyes, especially with eye movements.
  • Headache or migraine: The relationship between headaches and MS is not well known. People with MS are more likely to have headaches or migraine than those without MS. But it is not known if this is due to MS damage. It is also possible these conditions share common risk factors and occur alongside each other.

Types of secondary pain

Secondary pain is not directly related to MS damage. Instead, it is the result of other MS symptoms. Several examples of secondary pain include:1-3

  • General musculoskeletal pain: After years of having MS, the body may become weaker. This may lead to changes in posture. These changes in posture can cause achiness in many areas of the body.
  • Treatment-related pain: Some treatment options may have pain as a side effect. Drugs that are injected can cause injection site pain. Steroids may cause osteoporosis or joint damage related to changes in blood flow. Also, some immune system-impacting drugs can cause body aches.
  • Psychosocial pain: Our mental health is closely related to the way we perceive pain. Those with depression, anxiety, stress, or trauma are more likely to have severe or chronic pain.
  • Muscle spasms and spasticity: People with MS may eventually develop muscle spasms. This refers to hyperactivity of certain muscle groups causing pain and cramping.
  • Pain from other conditions: It is possible to have another pain-causing condition alongside MS. For example, irritable bowel syndrome and interstitial cystitis can also cause their own pain alongside MS symptoms.

Treating pain in MS

There are a variety of ways to treat pain. Each person’s response will be different. A doctor can help figure out what works for you. Common options for pain management include:1-3

  • Drugs: In many cases, drugs can be used to manage pain. These include NSAIDs (non-steroidal anti-inflammatory drugs like ibuprofen), anti-seizure drugs, antidepressants, opioids, cannabinoids, and more.
  • Topical treatments: Lidocaine patches, capsaicin cream, and heating pads may all help to manage pain.
  • Exercise:Stretching or light exercise, including water exercises, may decrease pain and improve mental health.
  • Neurostimulation: A method of pain control that uses devices to interrupt nerve communication. This can help reduce pain. The devices can be implanted inside the body or put in contact with the skin from the outside. An example of a neurostimulation device is a TENS unit. These are popular for help with menstrual pain.
  • Alternative and complementary methods: In addition to exercise and neurostimulation, there are many alternative and complementary pain relief options. These include acupuncture, therapy or other mental health support, relaxation techniques, hypnosis, and more.

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