Dysesthesia in MS: Feeling, causes, and treatment
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Multiple sclerosis (MS) is a disorder in which the immune system erroneously launches an attack that damages the central nervous system, which is comprised of the brain, spinal cord, and optic nerves. Abnormal physical sensations, referred to as dysesthesias, are among the MS symptoms that often result from such neurological damage.
What is dysesthesia?
Dysesthesia is often experienced as an aching or burning sensation in the skin. It is considered a type of neuropathic pain, meaning pain that results from nerve fiber damage.
This abnormal sensation can interfere with a person’s daily activities, sleep, and overall quality of life.
How is dysesthesia linked to MS?
Dysesthesia occurs in MS as a result of nerve damage that disrupts the normal communication between the brain and other parts of the body. It is considered a paroxysmal symptom of the disease, meaning that it is usually a neurological symptom (or a group of symptoms) that appears suddenly, lasts for only a few seconds or minutes, and then disappears.
The condition can take many forms in MS, presenting as unpleasant sensations such as pain, numbness, itching, burning, or tingling feelings. These abnormal sensations more commonly affect the arms, legs, face, or chest, but also can manifest in other regions, such as the genitals.
Two of the most common forms of dysesthesia experienced by individuals with multiple sclerosis are the MS hug and Lhermitte’s sign. Itching, known as pruritus, as well as hot feet — a sensation of being on fire — or MS foot pain, are other forms of dysesthesia also reported by these patients.
What does dysesthesia feel like?
Dysesthesia includes symptoms such as burning or stinging, pins and needles sensation, electrical sensations, itching, discomfort, or pain. It is described by patients as a skin-on-fire feeling, or that the body feels like burning. These symptoms may vary in intensity among individuals and over time.
The MS hug, also sometimes referred to as banding or girdling, is characterized by a feeling of pressure or pain around the chest — as if someone were giving a tight hug, hence the name.
While this sensation usually affects parts of the body between the waist and neck, specific symptoms vary from person to person, with some patients experiencing similar sensations in the hands or feet. Others may experience a “hug” only on one side of their body. The sensation may feel so tight the person finds it hard to breathe.
Lhermitte’s sign, meanwhile, is a sudden sensation that feels like an electric shock running from the neck down the spine, sometimes radiating out to the limbs and extremities. This form of dysesthesia is sometimes referred to as “barber’s chair syndrome,” as it is usually triggered by a neck movement that resembles tilting the head forward during a haircut.
Causes of dysesthesia
Although most symptoms of dysesthesia are felt in the skin, these sensations are of neurological origin. In MS, dysesthesia is caused by nerve damage in the central nervous system that results in the loss of myelin — a fatty, protective layer that surrounds nerve fibers and helps them send electrical signals.
Myelin loss can interfere with normal nerve function, causing some nerves to be overactive and fire too many electrical signals. As a consequence, abnormal sensations can be felt.
Importantly, dysesthesia-related sensations are not caused by damage to the tissues where they are felt, but rather a result of damage to the nerves that connect the brain to those specific regions in the body.
How long does dysesthesia last?
Regardless of the type of dysesthesia, episodes of these abnormal sensations usually start and end abruptly, lasting seconds to minutes, which is typical of paroxysmal symptoms. However, these symptoms are unpredictable and can occur several times a day.
Also, forms such as the MS hug can last for hours or even for a few days in some patients.
Does dysesthesia go away?
Dysesthesia can come and go, much like other MS symptoms. But some dysesthesias can be chronic, persisting for a certain amount of time (chronic pain).
Treatment of dysesthesia
While dysesthesias can be uncomfortable, they usually disappear in time without requiring treatment. Avoiding or minimizing specific triggers, such as drastic changes in temperature or wearing tight clothes, might be helpful in some cases.
Other management approaches, such as applying warm or cold compresses to affected areas, doing exercise — such as walking, stretching, yoga, gentle swimming — and practicing relaxation techniques, including meditation, deep breathing, and mindfulness also may be of benefit.
Additional approaches include physiotherapy, cognitive behavioral therapy (pain psychology), and the use of transcutaneous electrical nerve stimulation (TENS) units to block abnormal neuronal impulses. TENS units use low voltage electrical current that promotes pain relief — the electrical pulses relax muscles and reduce potential pain signals.
Treatment with specific medication might be considered if dysesthesia becomes considerably painful or if it interferes with a person’s day-to-day activities.
Neuropathic pain is treated differently than other types of pain. It is addressed with medications able to control overactive nerves. According to the National MS Society, two types of medications can be prescribed:
- anti-seizure/anticonvulsant medications, including gabapentin and pregabalin
- antidepressants, including amitriptyline and duloxetine
Notably, however, these medications are not approved in the U.S. to treat neuropathic pain. Instead, they are used off-label for this indication.
Healthcare providers also note that pain in the chest — as felt with the MS hug, but especially if it’s new and/or unexplained — also can be a sign of a heart attack or other serious problems. Thus, it is important that patients discuss any chest pain with a healthcare professional.
| Therapeutic Approaches for Dysesthesia Management | |
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| Medication |
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| Non-pharmacological approaches |
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Dysesthesia versus paresthesia
The terms dysesthesia and paresthesia both refer to abnormal nerve sensations. The main difference lies in the severity of these sensations.
Dysesthesia is an abnormal sensation that can become intense and/or painful. In contrast, paresthesia corresponds to altered sensations including numbness, tingling, or “pins and needles” sensations, that are usually painless and temporary.
Paresthesias are generally caused by sustained pressure on a nerve, and symptoms ease when pressure is relieved. Nevertheless, chronic paresthesia can be a symptom of nerve damage or of an underlying neurological disease such as MS.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about dysesthesia in MS
These abnormal sensations are not dangerous themselves. But dysesthesia can be uncomfortable, sometimes painful, and even scary if a person experiences symptoms such as an MS hug for the first time.
Dysesthesia is not life-threatening, but it can interfere with a person’s daily activities, disrupt sleep, and reduce quality of life.
Similar to other paroxysmal symptoms — which appear suddenly, last for a few seconds or minutes, and then disappear — dysesthesia may come and go. Some types of dysesthesias can be chronic (chronic neuropathic pain), persisting for a certain amount of time.
Anxiety and stress can serve as triggers for dysesthesia or exacerbate its symptoms. In some cases, chronic anxiety and stress can increase nerve firing and cause symptoms similar to dysesthesia, without the actual presence of nerve damage.
Dysesthesia is a type of neuropathic pain, or pain that results from nervous system damage. Therefore, neurologists are the best-qualified doctors to treat these abnormal sensations. A primary care physician could be a person’s first contact to discuss dysesthesia symptoms, but if these are serious or interfere with daily life, the patient should be seen by a neurologist.
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