The ABCs of Pain Management for Multiple Sclerosis

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About two-thirds of people with multiple sclerosis (MS) experience pain at some point during their illness. If you’re among them, getting your pain under control is a top priority. When your pain is well managed, you’ll feel more upbeat and ready to take on other challenges.

MS pain can take many forms, depending on the cause. There are three main sources:

• Nerve pain is caused by problems with the nerves that carry sensation. Depending on which nerves are affected, it may feel like a stabbing pain in your face or a burning, throbbing, aching, or prickling pain around your body. Another form of nerve pain is Lhermitte’s sign—a shock-like sensation that runs from the back of your head down your spine when you bend your neck forward.

• Muscle spasm pain occurs when a malfunction in nerve pathways makes your muscles squeeze and spasm painfully. Tightening of muscles around your joints may also lead to aching there.
  
• Other muscle and joint pain results when MS keeps you from moving or standing normally. Limping, twisting awkwardly, or using mobility aids incorrectly puts stress on muscles and joints, which may lead to aching or stabbing pain.

Because MS pain is a complex problem, there is no simple solution. That can be frustrating, especially when you’re suffering. But don’t give up. There are many different treatment options available. By working closely with your doctor, you can develop an effective pain management plan. Often, the journey to pain relief follows an ABC path.

• Anticonvulsant medications (such as Lyrica, Dilantin, Neurontin, and Tegretol) may ease various types of nerve pain, because their active ingredients improve the way the brain processes pain signals.

• Antidepressant medications (such as Anafranil, Cymbalta, Elavil, Norpramin, Pamelor, Sinequan, Tofranil, and trimipramine) may also relieve nerve pain by helping reset pain-controlling neurotransmitter levels.

• Antispasmodic medications (such as Lioresal and Zanaflex) help ease pain caused by muscle cramps and spasms.

• Additional treatments include over-the-counter or prescription-strength pain relievers. Talk with your doctor before using these medicines long-term, however. Nerve pain may be reduced by applying warm compresses or wearing pressure stockings or gloves. You may decrease muscle spasm pain by stretching regularly or adjusting your intake of fluids, sodium, and potassium. You may ease other muscle and joint pain by heat, massage, ultrasound treatments, or physical therapy.

• Benzodiazepine medications (such as Klonopin and Valium) are central nervous system depressants that also reduce muscle spasms. They’re not considered first-choice treatments because they cause drowsiness and can lead to dependence. But doctors sometimes prescribe a small dose at bedtime to control muscle spasms that disturb sleep.

• Botox injections may reduce muscle spasms. This allows for more natural posture and movements and may ease pain. The effects last up to three or four months.

• Baclofen pump (also called intrathecal baclofen) is an implanted pump that delivers a low, steady dose of medicine straight to the spinal cord. It may be used to treat severe muscle spasms.

• Complementary approaches address the emotional side of pain. Such approaches can be considered part of your pain management plan. Pain is distressing. But out-of-control stress, fear, and worry only make it harder to cope. This can make pain seem worse. Strategies such as breathing exercises, biofeedback, yoga, acupuncture, meditation, and hypnosis can help you take charge of pain and take on life with a positive attitude.

• About two-thirds of people with MS experience pain at some point during their illness. 

• There are three main sources of MS pain: nerve pain, muscle spasm pain, and other muscle and joint pain.

• These are exciting times because many innovative treatment strategies can safely and effectively control MS pain. Several medications and complementary approaches can bring relief. By working closely with your doctor, you can develop an effective pain management plan.