Pain

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Pain

http://www.nationalmssociety.org/Sourcebook-Pain.asp

From The MS Information Sourcebook, produced by the National MS Society.

Pain syndromes are not uncommon in MS. In one study, 55% of the people studied had what is called "clinically significant pain" at some time during the course of a lifetime with MS. Almost half (48%) were troubled by chronic pain. This study suggested that factors such as age at onset, length of time with MS, or degree of disability played no part in distinguishing the people with pain from the people who were pain free.

The study also indicated that twice as many women as men experienced pain as part of their MS.

Several Sources and Types of Pain in MS

Acute Pain

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 neurologic in origin. It can usually be treated successfully with medications such as 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 such as 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 is dysesthesias. 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.

Chronic Pain

Burning, Aching, Prickling, or "Pin 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 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 treatment described above.

Back and Other Musculoskeletal Pain in MS can have many causes, including spasticity. Pressure on the body caused by immobility, or 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.

Pain and the Emotions

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 indicated for chronic disabling pain, where medication in combination with alternative therapies, such as biofeedback, hypnosis, yoga, meditation, or acupuncture may be used. Self-help may play an important role in pain control, for people who stay active and maintain positive attitudes are often able to reduce the impact of pain on their quality of life.

Chapters of the National MS Society may be able to refer callers to area pain clinics or specialists.

Pain resources from NINDS

American Chronic Pain Association (ACPA)

P.O. Box 850

Rocklin, CA 95677-0850

ACPA@pacbell.net

www.theacpa.org

Tel: 916-632-0922, 800-533-3231

Fax: 916-632-3208

National Chronic Pain Outreach Association (NCPOA)

P.O. Box 274

Millboro, VA 24460

ncpoa@cfw.com

www.chronicpain.org

Tel: 540-862-9437

Fax: 540-862-9485

Mayday Fund [For Pain Research]

c/o SPG

136 West 21st Street, 6th Floor

New York, NY 10011

MaydyFnd@aol.com

www.painandhealth.org

Tel: 212-366-6970

Fax: 212-838-2896

American Pain Foundation

201 North Charles Street

Suite 710

Baltimore, MD 21201

info@painfoundation.org

www.painfoundation.org

Tel: 888-615-PAIN (7246), 410-783-7292

Fax: 410-385-1832

National Foundation for the Treatment of Pain

1330 Skyline Drive

#21

Monterey, CA 93940

markgordon@paincare.org

www.paincare.org

Tel: 831-655-8812

Fax: 831-655-2823

For information on other neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:

BRAIN

P.O. Box 5801

Bethesda, MD 20824

(800) 352-9424

www.ninds.nih.gov

See also...

Diagnosis

Headache

Spasticity

Symptoms

Last updated January 2004