Multiple sclerosis is a chronic, progressive disorder involving the central nervous system. It is an immunological disorder, which leads to damage of myelin sheath by auto-antibodies leading to nerve impulse conduction abnormalities. The symptoms are all related to disturbance in conduction of nerve impulses.
Apart from symptoms of paresthesias, weakness, speech problems, visual disturbances, pain is the most important and debilitating symptom associated with multiple sclerosis. Pain is a very personal emotional experience that varies from person to person and its intensity depends on the pain threshold of a person.
What Kind Of Pain Does Multiple Sclerosis Cause?
The pain of multiple sclerosis is mostly two types, namely, neuropathic pain and musculoskeletal pain. Neuropathic pain is due to the insult experienced by nerves at the hands of auto-antibodies in the central nervous system. It can be accompanied with paresthesias. Musculoskeletal pain is related to the insult beared by muscles, tendons and ligaments due to weakness of muscles.
Pain can also be classified by their chronicity, such as acute pain whose onset is sudden and chronic pain that is a longer lasting pain. Apart from acute and chronic pain, pain can also occur in bouts and flare-ups, known as paroxysmal pain causing spasms of muscles.
Neuropathic Pain. It can be divided into acute and chronic neuropathic pain. Acute pain has rapid onset and lasts for a shorter duration. These include
MS Hug. It is a restrictive, squeezing or sensation of tightness that can be felt in the chest, torso, waist, back or even extremities. It is a result of damage of nerve fibers of the spinal cord.
Trigeminal Neuralgia. TN affects the trigeminal nerve and affects the jaw and face and cause excruciating stabbing pain, often confused with dental pain.
Lhermitte’s Sign. It is a feeling of short electric pulse that may be felt in the cervical region and down the spine and extremities. It is due to insult to cervical spine.
Paroxysmal Spasm. It is an intermittent tightening of muscles of extremities and can be experienced several times a day.
Optic Neuritis. It is sharp, stabbing pain behind the eyes, caused by damage to optic nerve, also leading to vision problems.
Chronic Neuropathic Pain is caused by persistence of acute neuropathic pain. Acute pain can be turned into chronic pain, either by heat, stress, infection or fatigue.
Dysesthesias. It is a type of chronic pain associated with altered sensations due to damage of nerve sheath. It can be felt as stabbing, burning, electrical sensation, prickling, crawling, numbness, pins and needles, and itching.
Musculoskeletal Pain. It is mostly caused by insult to muscles, ligaments, tendons and other soft tissues due to weakness, stiffness and coordination problems caused by
Multiple sclerosis. This can affect gait and balance of a person. Spasticity also alters a person’s gait and leads to strain on joints and stiffness of muscles. It can affect various joints such as hip and back when affected can lead to altered gait. Other joints that are typically affected are knees and ankles. Musculoskeletal pain is mostly associated with muscle stiffness, weakness, spasms, fatigue leading to walking difficulties.
Management Of Multiple Sclerosis Pain
Approximately 80% patient experience pain at some point, so pain management is an important aspect in the management of multiple sclerosis. OTC medications are not effective in managing Multiple sclerosis pain symptoms as the pain is mostly neuropathic, in addition to musculoskeletal pain.
Pain is managed with the use of gabapentin, amitriptyline, and duloxetine, pregabalin, in cases of neuropathic pain, NSAIDs in cases of musculoskeletal pain and baclofen or other muscle relaxants for spasticity.
Apart from medications patients are also advised non-pharmacological interventions, such as cognitive behavioral therapy, physical therapy, massage, acupuncture, mindfulness and meditation, water therapy, application of cold or heat, yoga and stretching exercises. Pain in multiple sclerosis is managed in a multidisciplinary approach.
Positive attitude in patients with multiple sclerosis helps them in dealing with the condition with more resiliency.
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