Pain

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Pain is a common symptom in people with MS. Over half of people with MS report experiencing pain at some point, and in 10% to 20% of people this pain is a significant problem. For many people with MS, pain is a chronic problem. Pain associated with MS occurs due to nerve damage in the pathways that transmit sensory impulses to and from the brain.

 

What are the different types of pain that affect people with MS?

People with MS can experience many different pain syndromes which may involve acute pain (pain that is temporary) or chronic pain (pain of extended duration).

In MS, pain can be either primary pain, resulting from MS-related damage to the CNS, or secondary pain, resulting from another problem, such as spasticity or musculoskeletal problems.

Examples of primary pain syndromes common in MS are trigeminal neuralgia, a stabbing pain in the face which is sometimes confused for dental pain, Lhermitte’s sign, an electrical shock-like sensation extending from the back of the head down the spine and into the limbs, and dysesthesias which include burning and aching pains. Types of secondary pain include pain associated with spasticity (including muscle spasms or cramps), musculoskeletal pain (including pain resulting from incorrect use of mobility devices or from gait or balance problems), and emotional pain.

 

Headache pain

While headache is not recognized as a common symptom of MS, migraine headaches have been reported to be more common in people with MS. One study found that migraine was two times more common in people with MS compared with a non-MS control group. In another study, among a group of patients with MS, 20% had a family history of migraine, compared with only 10% of non-MS controls. Yet another study found that in a group of patients with MS, over 30% had a previous diagnosis of migraine.

 

What are the treatment options for primary pain syndromes?

In general, primary pain syndromes do not respond to standard pain medications (non-narcotic analgesics) such as Tylenol (acetaminophen) or ibuprofen (Motrin or Advil). Nor do they respond well to narcotic analgesics (eg. opioids) which are often combined with non-narcotic analgesics.

Primary pain syndromes in MS

Description
Management options
Trigeminal Neuralgia
  • Stabbing pain in face
  • Can appear as initial MS symptom
  • Confused for dental pain, but is neuropathic (trigeminal nerve damage)
  • Typically treated with anticonvulsants Tegretol® (carbamazepine) or Dilantin® (phenytoin)
  • Surgical procedure percutaneous rhizotomy may be used in cases where there is no response to medication
Lhermitte’s sign
  • Brief, stabbing pain
  • Feels like an electric shock running from back of head down spine
  • Brought on by bending neck forward
  • Anticonvulsant medications can be used to prevent
Dysesthesias
  • Burning, aching pain
  • Can involve a girdle band-like pressure
  • Neurologic in basis (due to damage to nerves)
  • Typically treated with anticonvulsant Neurontin® (gabapentin)
  • May also be treated with an antidepressant such as Elavil® (amitriptyline)
  • Cymbalta® (duloxetine hydrochloride) and Lyrica® (pregabalin), which have been FDA approved for pain associated with other diseases, including diabetes, may also be considered
  • Non-drug treatments: warm compresses, acupuncture, relaxation

 

What are the treatment options for secondary pain?

Treatments for secondary pain include therapy options to address the underlying cause of pain. For instance, muscular stiffness or spasticity is treated with a range of medications, such as Lioresal® (baclofen) or Zanaflex® (tizanidine), as well as non-pharmaceutical options, including stretching and acupuncture. Treatments for musculoskeletal pain depend on the source of pain and may combine medications, massage, ultrasound, and physical therapy.

Types of secondary pain common in MS

Description
Management options
Pain of spasticity
  • Muscle spasms or cramps (flexor spasms)
  • Tightness and aching joints
  • Lioresal® (baclofen) or Zanaflex® (tizanidine)
  • Ibuprofen or other prescription strength anti-inflammatory agents
  • Non-drug treatments include regular stretching and acupuncture
Musculoskeletal pain
  • Causes include spasticity, immobility, incorrect use of mobility devices, gait or balance problems
  • Massage, ultrasound, physical therapy, heat
  • Medications to control symptoms, such as drugs to relieve back spasms
  • Instruction on correct use of mobility devices
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