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  • Writer's pictureDr. Harold Pierre

Chronic Pain in Multiple Sclerosis

What is Multiple Sclerosis?


Multiple sclerosis (MS) is a disease that wrecks the central nervous system. That includes the brain, spinal cord, and optic nerves. With MS, the immune system mistakenly attacks the myelin sheath that covers and protects nerve fibers.


Myelin helps nerve signals travel faster. When the myelin becomes damaged, messages slow down or can't get through. This communication breakdown causes MS symptoms. Doctors call the damage to myelin and nerves in the central nervous system "lesions." This breakdown changes how the brain perceives the messages. Imagine that cell phone call with a "poor signal" and the brain is the listener. 


Multiple Sclerosis concept and nerve disorder and damaged myelin or MS autoimmune disease with healthy nerve with exposed fibre with scarred cell sheath loss with 3D illustration elements

Who Gets MS?


Most people are diagnosed between the ages of 20 and 50. Women develop MS around 3 times more than men. MS isn't directly passed from parent to child, but genetics may increase risk.


Caucasians face higher rates of MS, especially those descended from Northern Europeans. MS isn't picky though - every ethnicity can develop it. Certain viral infections and low vitamin D levels may also increase susceptibility. It seems like the further away you live from the equator, the higher the occurrence of MS.


What Are Typical MS Symptoms?


Symptoms vary widely because lesions can form anywhere in the central nervous system. Early on, flare-ups of symptoms happen, with periods of remission in between. People with MS may complain of:

  • Vision problems

  • Numbness

  • Weak limbs

  • Walking difficulties

  • Bladder issues

  • Sharp, electric-like nerve pain

Over time, flare-ups tend to get milder, but disability can worsen steadily. Most people end up with some permanent symptoms like speech issues, and chronic pain (MS pain). and balance issues. Typically, life expectancy is lowered by around 5 to 10 years.


Chronic Pain in MS


Chronic pain is a prevalent and often debilitating aspect of multiple sclerosis (MS), affecting a significant portion of those diagnosed with the condition. Studies suggest that up to 80% of individuals with MS experience some form of pain during the course of their illness.


The two primary types of pain in MS are neuropathic and musculoskeletal. Neuropathic pain, related to the direct impact of MS on the nervous system, is reported by approximately 50% of MS patients. This type of pain includes sensations such as burning, stabbing, or electric-shock-like pains, often resulting from nerve fiber damage. It can be particularly debilitating due to its intensity and the difficulty in managing it with traditional pain relievers.


Musculoskeletal pain, on the other hand, is experienced by around 40-50% of MS patients. This form of pain typically arises from the muscular strains and joint stress caused by the mobility and coordination challenges associated with MS. For instance, uneven gait patterns can lead to significant joint and muscle discomfort, significantly impacting daily activities.


Areas affected by MS lesions conduct amplified pain signals to the brain due to central sensitization - an increased sensitivity and overreaction to pain by the brain and spinal cord. The pain associated with this sensitization is referred to as central pain. Many people with MS suffer from central pain. Inflammation in the nerves can also directly provoke pain. 


Common chronic pain complaints include:


  1. Trigeminal neuralgia - Repeated facial pain similar to an electric shock

  2. Muscle stiffness and painful spasms

  3. Neuropathic pain in the arms and legs - Burning, shooting, stabbing sensations

  4. Lower back pain - Soreness, stiffness, spasms

  5. Painful optic neuritis - Severe pain behind the eyes

  6. Lhermitte's sign - Electric shock sensation moving down the spine and limbs

  7. Foot drop - Weakness that causes toes to drag painfully while walking

  8. Allodynia - Pain from non-painful stimulation like light touch

  9. Hyperalgesia - Heightened pain response to mildly painful stimuli

  10. Dysesthesia - Unpleasant abnormal sensations such as tingling or burning

  11. Dysaesthesia - Reduced or absent sensation leading to uncomfortable numbness

  12. Girdling chest and abdomen pain from MS hugs

  13. Tonic spasms - Sustained and painful tightening of muscles

  14. Chronic migraine headaches resulting from MS lesions

  15. Painful bladder spasms causing urgency and frequency

  16. Pelvic floor dysfunction leading to pain with urination, bowel movements, or sex

  17. Sexual dysfunction including genital sensory loss and arousal difficulties

  18. Dyspareunia - Pain during sexual intercourse

  19. Painful menstrual cramps and ovulation caused by neural inflammation

  20. Proctalgia fugax - Spasms and pain in the rectum and anal sphincter muscles

  21. Coccydynia - Chronic pain in the tailbone region from lesions near spinal nerves

  22. Vulvodynia - Unexplained burning, stabbing vulvar pain caused by nerve damage

  23. Glossopharyngeal neuralgia - Throat and tongue pain

  24. Oral dysesthesia - Uncomfortable numbness and tingling in the mouth.


Multiple Sclerosis concept and nerve disorder and damaged myelin or MS autoimmune disease with healthy nerve with exposed fibre with scarred cell sheath loss with 3D illustration elements  copy

Treatment Options for Chronic Pain in MS


Chronic pain in multiple sclerosis (MS) can be managed through various treatment approaches. Neuropathic pain, a common type of MS, is often treated with medications originally developed as anticonvulsants or antidepressants. These include drugs like Neurontin (gabapentin), Tegretol (carbamazepine), Dilantin (phenytoin), and tricyclic antidepressants such as amitriptyline. For spasticity-related pain, medications such as baclofen and Zanaflex (tizanidine) can be effective in improving quality of life. In severe cases, Botox injections or a baclofen pump may be considered.


Physical therapy and stretching are particularly beneficial for spasticity and musculoskeletal pain. Light walking or circuit training exercises are recommended, along with yoga for some patients. Other complementary treatments like warm compresses, massage therapy, acupuncture, mindfulness, or meditation may also provide relief.


Nutrition, focusing on hydration and intake of potassium and magnesium-rich foods, can help prevent cramps. It's important to have an open dialogue with healthcare providers to find the most effective combination of treatments for individual pain management in MS.


Treating Chronic Pain In MS With Spinal Cord Stimulators


Spinal cord stimulators (SCS) are devices used to send mild electrical signals near the spinal cord to control chronic pain. The stimulation changes the way pain signals are sent to the brain and thus changes the way the brain perceives the pain. They are typically considered for chronic pain conditions such as chronic back pain that have not responded to other treatments. 


I've included a reference to a study, "Is there a place for spinal cord stimulation in the management of patients with multiple sclerosis? A systematic review of the literature." The study indicates that Spinal Cord Stimulation (SCS) may help for certain symptoms in MS patients. Specifically, SCS showed improvements in managing MS-related urinary dysfunction and neuropathic pain. However, the response to SCS for motor disorders in MS was less pronounced. SCS therapy provides a sustainable improvement in pain, sleep, mobility, and the ability to reduce pain medications for properly selected patients. This suggests that SCS may be more beneficial for specific symptoms rather than others. 


Key Takeaways


  • 80% of MS patients experience chronic pain, making it a common and often debilitating symptom.

  • Two main types: Neuropathic pain (burning, stabbing) and musculoskeletal pain (muscle strains, stiffness).

  • Treatment options: Medications, physical therapy, yoga, massage, and even spinal cord stimulation for specific cases.

  • Don't suffer in silence: Find the right combination of treatments for your unique pain journey.


Racke, M. K., Frohman, E. M., & Frohman, T. (2022). Pain in Multiple Sclerosis: Understanding Pathophysiology Diagnosis and Management Through Clinical Vignettes. Frontiers in Neurology, 12, 799698. https://doi.org/10.3389/fneur.2021.799698


Rapisarda, A., Ioannoni, E., Izzo, A., D’Ercole, M., & Montano, N. (2021). Is there a place for spinal cord stimulation in the management of patients with multiple sclerosis? A systematic review of the literature. Minimally Invasive Surgery, 2021, Article ID 9969010.


About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.

 

This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.







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