Sources and Types of Pain in MS

Trigeminal neuralgia is a stabbing pain in the face. It can occur as an initial symptom of MS. While it can be confused with dental pain, this pain is neuropathic (caused by damage to the trigeminal nerve) in origin. It can usually be treated with medications such as the anticonvulsants carbamazepine (Tegretol^®) or phenytoin(Dilantin^®).

Lhermitte’s sign is a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward. Medications, including anticonvulsants, may be used to prevent the pain, or a soft collar may be used to limit neck flexion.

Burning, aching or “girdling” around the body are all neurologic in origin. The technical name for them isdysesthesias. These pains are often treated with the anticonvulsant medication gabapentin (Neurontin®). Dysesthesias may also be treated with an antidepressant such as amitriptyline (Elavil^®), which modifies how the central nervous system reacts to pain. Other treatments include wearing a pressure stocking or glove, which can convert the sensation of pain to one of pressure; warm compresses to the skin, which may convert the sensation of pain to one of warmth; and over-the-counter acetaminophen (Tylenol^® and others) which may be taken daily, under a physician’s supervision.

Duloxetine hydrochloride (Cymbalta®) was approved by the FDA in 2004 for treatment of depression and treatment of pain associated with diabetic peripheral neuropathy. Cymbalta® belongs to the group of medications known as selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Although not specifically approved for use in MS, its effectiveness in diabetic neuropathy makes it a suitable candidate for the treatment of neuropathic pain in MS, and MS specialists consider it a good treatment option for people with MS.

Pregabalin (Lyrica®), also approved by the FDA in 2004, is recommended for the treatment of neuropathic pain associated with diabetes, fibromyalgia and certain types of seizures. Although not specifically approved for use in MS, it is also considered a good treatment option for people with MS.

Burning, aching, prickling or “pins and needles” may be chronic rather than acute. The treatments are the same as for the acute dysesthesias described above.

Pain of spasticity has its own subcategories. Muscle spasms or cramps, called flexor spasms, may occur. Treatments include medication with baclofen (Lioresal^®) or tizanidine (Zanaflex^®), ibuprofen, or other prescription strength anti-inflammatory agents. Treatment also includes regular stretching exercises and balancing water intake with adequate sodium and potassium, as shortages in either of these can cause muscle cramps. Tightness and aching in joints is another manifestation of spasticity, and generally responds well to the treatments described above.

Back and other musculoskeletal pain in MS can have many causes, including spasticity. Pressure on the body caused by immobility, incorrect use of mobility aids, or the struggle to compensate for gait and balance problems may all contribute. An evaluation to pinpoint the source of the pain is essential. Treatments may include heat, massage, ultrasound, physical therapy and treatment for spasticity.

Most pain in MS can be treated. But not all pain a person with MS has is due to MS. Whatever the source, pain is a complex problem that should not be ignored. Many factors may contribute, including fear and worry. A multidisciplinary pain clinic may be able to treat chronic disabling pain with medication in combination with such alternative therapies as biofeedback, hypnosis, yoga, meditation or acupuncture. Self-help may also play an important role in pain control. People who stay active and maintain positive attitudes are often able to reduce the impact of pain on their quality of life.

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