| Pain Management for People with MS |
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Historically, multiple sclerosis (MS) was thought to be a disease in which pain was not a symptom. However,
pain is something, which we now know, is a symptom in people with MS. In fact it is estimated that about
half of the people diagnosed with MS experience pain due to MS. In some people it can be a significant problem.
To properly treat pain, it is extremely important that a source of the pain, other than MS, be
investigated as there are many other conditions that can cause pain. Pain is the way your body
tells you that something is wrong. You and your doctor should always look for what is causing
this problem before assuming it is “just the MS.”
MS pain can be due to different sources. There is neurological pain due to the “short circuiting”
of the nerves that carry sensation. In addition, there can be musculoskeletal pain due to movement
dysfunction. Finally, there can be pain due to a combination of the two.
Neurological pain can be manifested through feelings of burning or tingling sensations. It
can also be a “dull ache”. It is most commonly experienced in the extremities. Other types
of neurological pain seen in people with MS are trigeminal neuralgia, a severe facial pain, and
L’hermitte’s sign, an electrical sensation felt down the spine and into the legs when the head
is moved forward. Neurological pain can be frustrating and in some cases debilitating.
Current treatment for neurological pain is generally through medications. Some medications
commonly used are anti-depressants and anti-convulsants. Older anti-depressants such as
Elavil can be useful, but may be too sedating. Effexor is a newer anti-depressant that
can be helpful and may actually boost energy levels for some. Many older and newer anti-convulsants
can be used for pain management. Older options include Dilantin and Tegretol. Newer options include
Neurontin, Gabitril and Zonegran. Some treatments could work for both burning pains and for
painful spasticity. These include Zanaflex, Neurontin and Gabitril. In addition, techniques such as
biofeedback and meditation can be helpful in managing the pain. These techniques are primarily
utilized to help treat the person’s response to the pain. This is very important because often
the severity of a person’s pain is increased when they are not able to properly manage the pain.
Finally, surgical procedures can be used to treat pain but are generally used only if other
treatments are not effective in controlling or managing the pain. These procedures can produce s
ide effects such as numbness, but this is often much less problematic than the pain.
Musculoskeletal pain is most commonly due to “abnormal” movement patterns due to the MS symptoms.
Increases in spasticity and weakness can change the way a person moves. It is also fairly common
to see individuals experiencing low back pain because of a change in the way they walk or due
to poor sitting posture. In addition, they may experience “overuse” syndromes secondary to
weakness and/or tightness. Other musculoskeletal pain may include orthopedic problems to the
joints. For example, it is not uncommon for a person with MS to exhibit knee
hyperextension during ambulation (walking). This repeated hyperextension can lead to problems
with the knee joint.
Treatment of musculoskeletal pain may include anti-inflammatory medications to address swelling.
However, physical and occupational therapy are important in addressing musculoskeletal pain for
people with MS. A thorough evaluation by your doctor is necessary to identify what is causing
the pain and movement dysfunction. Symptom management medications may also be recommended to
minimize the effects of symptoms such as spasticity on movement. In addition, rehabilitation can
be helpful in addressing restoration of movement which, in turn, will minimize the pain secondary
to the “abnormal movement”. This may include training in proper ambulation, transfer techniques
and training of family members. In addition, a therapist may recommend and train a person in the
use of assistive equipment. Utilization of proper assistive equipment can also help correct
movement abnormalities and minimize the associated pain. Assistive equipment may include
ambulatory aids such as canes, walkers or crutches to improve the walking pattern. In addition,
transfer aids such as grab bars can be helpful. Finally, evaluation of worksites,
seating systems and home environment can be helpful in improving overall posture with
daily activities which may be contributing to a person’s pain.
MS pain can be a frustrating and sometime difficult symptom to manage. It is important to utilize
a multidisciplinary approach to managing the pain. As stated, pain can be a combination of
neurological and musculoskeletal problems. A thorough assessment and consultation with members
of your MS management team is often the most effective approach to managing pain.
Ben Thrower, MD
Brian Hutchinson, PT |
| - reprinted with permision from- The Heuga Center . |
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