Pain and Multiple Sclerosis
Pain is a common multiple sclerosis (MS) symptom, experienced by more than 60 percent of people with MS at some point. If left untreated, pain can affect relationships, mood, sleep, work, and your ability to enjoy life. The good news is that pain is manageable - but it usually requires more than one approach.
Types of Pain in MS
MS tends to cause two main kinds of pain: neuropathic (nerve) pain and musculoskeletal (muscle and bone) pain.
Neuropathic pain is caused directly by MS. Lesions in the brain or spinal cord can cause nerves to fire inappropriately, disrupting the normal signals that carry sensations. This pain can be steady or intermittent. Steady neuropathic pain is often described as burning, tight, tingling, nagging, aching, throbbing, or icy. It is the more common type. Intermittent neuropathic pain comes in sudden bursts and is often described as shooting, stabbing, or like an electric shock. Other unpleasant sensations — such as the feeling of crawling bugs, water running down an arm or leg, or pins and needles — are also caused by abnormal nerve firing and can become bothersome enough to require treatment.
Some of the most common neuropathic pains in MS include burning pain in the legs or arms, trigeminal neuralgia (sudden stabbing pain in the face), and Lhermitte’s sign (a shock-like sensation down the back and into the arms when you dip your chin to your chest). People with MS are also more prone to migraines.
Musculoskeletal pain results from the physical effects of living with MS. Muscles, bones, and joints can become painful when stressed by decreased mobility, prolonged sitting, spasms, or compensating for weak muscles. For example, if you use your back muscles to make up for weak leg muscles, you may develop back pain from overuse. Sitting or lying in one position for too long limits blood flow and increases pressure, which can lead to aches, numbness, and spasms.
If you notice a new onset of pain, report it to your health care provider. New pain may reflect a new MS lesion or a relapse.
Tracking Your Pain
Keeping a pain journal can help you and your provider find the best treatment approach. Write down what the pain feels like, when it starts and stops, where on your body it occurs, what makes it worse, and what makes it better. Also note any treatments you are already using, such as over-the-counter medications, supplements, or complementary therapies like acupuncture. The more detail you can share, the easier it is for your provider to understand your pain and choose the right treatment.
Treating Pain
Managing MS pain usually works best with a combination of approaches.
Medications. Anti-seizure medications (like gabapentin) are frequently used for neuropathic pain. They work by calming inappropriate nerve firing and stabilizing nerve cells. Antidepressant medications are also used - they can stabilize nerve cell chemicals and boost neurotransmitters that soften the perception of pain. These medications may take time to become effective, sometimes up to a month with a slow increase in dose to manage side effects. Muscle relaxants can help control painful spasms. The use of opioids remains controversial in MS pain management and is generally only considered when other treatments are not effective or well tolerated.
Physical approaches. Heat, cold, and pressure can help limit pain signals. Physical therapy, exercise, massage, acupuncture, yoga, tai chi, and transcutaneous electrical nerve stimulation (TENS - the use of mild electrical current to stimulate nerves) may all be helpful.
Pain psychology. This is a well-accepted and important part of pain management. How you feel emotionally - including feelings of anger, fear, anxiety, depression, and boredom - can directly affect how intense your pain feels. Lack of sleep, loneliness, and fatigue also make pain worse. Relaxation, meditation, guided imagery, mindfulness, hypnosis, biofeedback, and distraction are all strategies that can increase your tolerance to pain. Staying involved in work, social activities, support groups, or hobbies - even just having a good laugh - can make a meaningful difference. Learning to manage pain through coping takes more effort than taking a pill, but the rewards are often greater and longer lasting.
Your Action Plan
Managing pain means developing a personal plan. Make it specific, flexible, and positive - and write it down. Consider what emotional and environmental factors may be triggering or worsening your pain. You do not need to do this alone. Ask about the pain team at your VA facility, or request a referral to a mental health professional who can assess your mood and offer individual or group counseling. Look at your social activity - could getting out of the house more, calling a friend, or joining a gentle yoga class make a difference?
Pain is manageable when tackled with a combination of medications, physical treatments, emotional and psychological strategies, and social support. It will not happen overnight, but with the right plan and help from your VA health care team, you can reduce the impact of pain on your life.
Based on articles by Heidi Maloni, PhD, APRN, BC-ANP, CNRN, MSCN.
