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Guest allan

Pain: From The Ms Information Sourcebook

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Guest allan

Pain

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 neuropathic (caused by damage to the trigeminal nerve) in origin. It can usually be treated successfully 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 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.

    Duloxetine hydrochloride (Cymbalta®) was approved by the U.S. Food and Drug Administration (FDA) in 2004 for the treatment of depression and the 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 physicians consider it a good treatment option for people with MS.

  • 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 (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 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.

    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.

    Helpful Organizations

    Trigeminal Neuralgia Association (TNA)

    2801 SW Archer Road

    Gainsesville , FL 32608

    Phone: 1-800-923-3608 or (352) 376-9955

    Email:

    Web site:


    American Chronic Pain Association

    P.O. Box 850

    Rocklin , CA 95677

    Phone: 1-800-533-3231

    Email:

    Web site:


    National Chronic Pain Outreach Association (NCPOA)

    P.O. Box 274

    Millboro, VA 24460

    Phone: (540) 862-9437

    Email:

    Web site :


    Mayday Fund (for pain research)

    c/o SPG

    136 West 21 st Street , 6 th fl.

    New York , NY 10011

    Phone: (212) 366-6970

    Email: (Mayday Pain Porject)

    Web site:


    American Pain Foundation

    201 North Charles Street, Suite 710

    Baltimore , MD 21201

    Phone: 1-888-615-PAIN (7246) or (410) 783-7292

    Email:

    Web site:


    National Foundation for the Treatment of Pain

    P.O. Box 70045

    Houston , TX 77270

    Phone: (713) 862-9332

    Email:

    Web site:


    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

    Phone:1-800-352-9424 or (301) 496-5751

    Web site:


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    See also...

    Sourcebook

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