Multiple Sclerosis and Pain

Multiple Sclerosis (MS) is a chronic disease that affects the central nervous system. It can cause a range of symptoms, including pain. Pain is a very personal experience, one that you can feel but others cannot see. It is common in MS and can limit your ability to do things that you enjoy. Understanding the different types of pain in MS can help you manage your symptoms better and improve your quality of life.

Neuropathic pain is one type of pain that is directly caused by damage to nerves in the central nervous system. In MS, neuropathic pain happens from “short circuiting” of the nerves that carry signals from the brain to the body. These pain sensations feel like burning, stabbing, sharp, and squeezing sensations. Neuropathic pain can be acute or chronic. Acute neuropathic pain is sometimes an initial symptom of MS or may be part of an MS relapse. Types of acute neuropathic pain include trigeminal neuralgia (TN), Lhermitte’s sign, MS Hug, and paroxysmal spasms. Chronic neuropathic pain is typically the persistence of an acute pain like those described above. In MS, these pains can be experienced on a daily or nearly daily basis and often it is unpredictable when they will occur.

Trigeminal neuralgia is a stabbing pain in the face or jaw area that can occur as an initial symptom of MS or as a relapse. While it can be confused with dental pain, this pain is neuropathic in origin (caused by damage to the trigeminal nerve). This pain often comes and goes and it is unpredictable when it might occur. Lhermitte’s sign is a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine and often into the arms or legs, brought on by bending the neck forward. It typically means there is or has been damage from MS in the cervical spine (neck). When this happens for the first time it could be a relapse or a first sign of MS. MS Hug is a squeezing sensation around the torso that feels like a blood pressure cuff when it tightens. This too is from damage to the spine from MS and could be a first symptom of MS or a relapse. Paroxysmal spasms are intermittent and painful tightening of muscles, such as in your arm or leg that may occur many times throughout the day or night.

Dysesthesias are another type of chronic pain that is not typically associated with a relapse. These are painful sensations that can affect the legs, feet, arms, and hands and feel like burning, prickling, stabbing, ice cold or electrical sensations. They can interfere with daily activities, sleep, and overall quality of life. Pruritis (itching) is a form of dysesthesias and may occur as a symptom of MS. It is one of the family of abnormal sensations — such as “pins and needles” and burning, stabbing, or tearing pains — which may be experienced by people with MS. These sensations are known as dysesthesias, and they are neurologic in origin.

Musculoskeletal pain is another type of pain that is common in MS. It is typically caused by an injury, like a sprained ankle or a pulled muscle. In MS, musculoskeletal pain occurs because of weakness, stiffness, or coordination problems that alter your walking or other mobility. For example, if you have leg weakness, it’s likely you do not have the same gait (walk) that you did before MS. Chances are you swing your leg or hike up your hip to avoid tripping.

Pain can be treated with both pharmacologic (medication) and non-pharmacologic (not using medication) interventions. Treatment should be designed to address the cause or source of your pain. For example, if you have back and hip pain from an abnormal gait because of leg weakness, the treatment should be designed to improve strength and gait rather than just treat the pain. Spasticity management may include medication to lessen the stiffness and stretching exercises that can reduce stiffness.

Neuropathic pain from MS is treated differently than other types of pain. It does not usually respond to Tylenol® or Motrin® like other pains do. Also, it generally does not respond to strong medications, called narcotics or opioids, that are sometimes used to treat pain after surgery. Neuropathic pain is treated with medications that settle down nerve overactivity. The medications generally used to treat neuropathic pain, both acute and chronic forms, include anti-seizure medications and certain types of antidepressants. These medications are not approved for use to treat pain from MS by the Food and Drug Administration (FDA) and are used “off-label” in MS.