Multiple sclerosis (MS) is unpredictable, and its signs and symptoms can vary widely, depending on the amount of nerve damage and the specific nerves affected.
Pain, unfortunately, is among the more common symptoms of MS, with one study estimating that more than 50 percent of all patients experience significant pain at some point, and almost 50 percent have chronic pain. Pain is also a more common disease symptom in women than in men.
Describing pain
MS patients often have trouble identifying and describing the pain they experience, possibly because its sensations can vary enormously. But that difficulty can make pain a difficult symptom to manage. Patients best able to effectively describe the nature of the pain they are experiencing are most likely to find a way to treat or ease it.
Commonly described types of MS-related pain range from uncomfortably cold or hot sensations and pins and needles, to a stabbing sensation similar to an electric shock, or a burning or aching sensation often around the legs or trunk.
Types of MS-related pain
MS related pain can be acute (temporary pain) or chronic (extended duration), and can be further categorized as primary and secondary depending on whether it stems directly from damage to the central nervous system, or results more indirectly from other MS symptoms and stresses.
Trigeminal neuralgia, Lhermitte’s sign and dysesthesia are examples of primary pain syndromes in MS. Spasticity-related pain and musculoskeletal pain are typical secondary pain MS syndromes.
Therapies for Managing Pain in MS
Two broad categories of treatments exist for MS-related pain: those that are not based on prescription medicines and those that are.
Non-drug therapies
Prescription medicines are not advised as a sole means of managing pain. Although useful, they can have side effects.
Common non-drug therapies for MS pain management include physiotherapy, occupational therapy, transcutaneous electrical nerve stimulation (TENS) and relaxing exercises such as yoga, Tai Chi and acupuncture.
Drug therapies
Even though medicines to manage pain should not be a sole resort, they often are an important part of pain management. These treatments include:
Amitriptyline is an antidepressant. In MS patients it is used to treat nerve pain, burning sensations, pins and needles, and stabbing pains in the arms or legs. Side effects may include gastric disorders, mouth pain or an unusual taste in mouth, black tongue, weight gain, itching or a rash, swelling of the breasts (in both men and women), impotence, and difficulty in having an orgasm.
Atarax (hydroxyzine) is an antihistamine, generally used to treat or prevent allergy symptoms. In MS patients it is used to relieve sensory symptoms, including itching or burning sensations. Common side effects include dizziness, drowsiness, blurred vision, dry mouth, and headache.
Deltasone (prednisone) is a corticosteroid, typically used to treat inflammation and to suppress the immune system. In MS patients it is used to manage acute exacerbations. Side effects can include insomnia, mood changes, increased appetite, gradual weight gain, acne, increased sweating, skin problems, headaches, nausea, and gastric disorders.
Dilantin (phenytoin) works as an anticonvulsant. In MS patients the drug is used to reduce painful sensations caused by demyelination of sensory pathways in the brain and spinal cord. Common side effects include nausea, vomiting, constipation, dizziness, nervousness, and sleep disorders.
Klonopin (clonazepam) belongs to group of drugs called benzodiazepines. It slows nerve messages in the central nervous system (brain and spinal cord). In MS patients it is used to manage pain or spasticity. Side effects can include drowsiness, dizziness, problems with walking or coordination, depression, fatigue, and problems with memory.
Neurontin (gabapentin) is an anti-epileptic drug, used in MS patients to control pain caused by nervous system lesions and spasticity. Common side effects include dizziness, drowsiness, and headache.
Pamelor and Aventin (nortriptyline) are antidepressants. In MS patients, these drugs are used to treat neuropathic or nerve pain in the arms and legs (burning sensations, pins and needles, and stabbing pains). Side effects can include gastric disorders, mouth pain or an unusual taste, black tongue, appetite or weight changes, itching or rash, breast swelling (both genders), impotence, and difficulty having an orgasm.
Pyridium (phenazopyridine) is a pain reliever for the lower part of the urinary tract. Although not an antibiotic, phenazopyridine is used to treat urinary tract infection, and relieve feelings of pain, burning and discomfort while urinating. Common side effects include headache, dizziness, stomach pain, upset stomach, and skin itching.
Tegretol (carbamazepine) is an anticonvulsant, generally used to treat seizures and nerve pain. In MS patients it is used to relieve the shock-like pain caused by trigeminal neuralgia (a chronic pain that affects the trigeminal nerve, which carries sensations from the face to the brain), as well as pain associated with spasticity and spasms. Common side effects can include dizziness, loss of coordination, problems with walking, nausea, vomiting, and drowsiness.
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