The MS hug is a common symptom of multiple sclerosis that can be hard to explain, and can be mistaken for other conditions. With the MS hug, you feel as if you have a tight band around your chest or ribs or pressure on one side of your torso. Some people find that it is painful to breathe.
Any pain in the chest needs checking by a doctor unless you are sure of the cause, for instance if you have already been diagnosed with the MS hug and the symptoms have not changed. The MS hug is not dangerous but any chest pain should be taken seriously just in case it needs immediate medical attention like heart or breathing problems.
It is best not to assume that what you are experiencing is part of your MS but to get checked out by a health professional straight away. Your MS nurse may be available at short notice or it may be quicker to see your GP. If you are at all worried about pain in your chest or if you have severe chest pain or difficulty breathing, you should go straight to the accident and emergency department of your local hospital.
What is the MS hug?
The MS hug, also known as banding or girdling, is a symptom of multiple sclerosis in which you feel chest pain, rib pain or a tight uncomfortable band around your chest. It can be felt anywhere between the neck and the waist and may feel so tight around the chest that it’s painful to breathe. For some people, it can be pressure on just one side of their body.
Some people experience a symptom similar to the MS hug but in their hands or feet, where it feels as though you are constantly wearing gloves or boots. For others, the tight feeling is around the head. The feeling can range from annoying to very painful. The feeling is different for everyone and may be described as pressure, an ache, a tickle, a pain or a burning feeling. It may be sharp or dull and can be short or long lasting.
Consultant neurologist, Dr Kate Petheram, sums up MS hug
Describing your MS hug
The MS hug feels different to each person. You can help your health professionals by describing what you are experiencing as accurately as possible. This means that they can understand what it feels like for you and what effect it is having on your everyday life. You might like to think about whether the feeling:
comes in short or long lasting bursts or is there all the time
is sharp or dull
feels painful, aching, burning, tight or like a pressure? Or is it some other feeling Can you describe it even if it seems odd?
is relieved by changes you have made like tighter or looser clothing or by applying heat or cold
started suddenly or increased bit by bit
started at the same time as other new symptoms or when previous symptoms came back quite suddenly
has happened before? When? Does it feel the same?
is stopping you doing what you’d like to do. Give some examples such as it’s affecting your sleep, work or ability to move freely. It is good to say exactly what’s happening, for example, it takes you two hours to get to sleep or you can only sit still for 20 minutes at a time.
In this film, young people learn about the MS hug using elastic bands, and discuss how it might feel to experience the MS hug.
What causes the MS hug?
The MS hug occurs because messages from nerves are blocked or disrupted by the damage caused by MS. The feeling of tightness around your chest can be due to spasms in the small muscles between your ribs (the intercostal muscles) which help expand your chest when breathing. The odd sensations, including aching, stabbing, crawling or pins and needles, are classed as a kind of nerve pain known as dysaesthesia (meaning “not normal sensation”).
How many people get the MS hug?
The MS hug is quite a common symptom of MS but is not well known, especially to people who have just been diagnosed. It can be surprising or worrying if the MS Hug sensations suddenly appear from nowhere.
What can I do if I have the MS hug?
Any pain in the chest needs checking by a doctor unless you are sure of the cause, for instance if you have already been diagnosed with the MS hug and the symptoms have not changed. If you are at all worried about pain in your chest or if you have severe chest pain or difficulty breathing, you should go straight to the accident and emergency department of your local hospital.
If other MS symptoms have come on suddenly at the same time, it may be part of a relapse so it is best to consult your MS nurse or neurologist as soon as possible to see if steroids would help.
Like many MS symptoms, the MS hug may appear or get worse if you are heat sensitive, stressed, have an infection, like a cold, flu or bladder infection, or fatigued. Consequently, it is important to cool down, get treatment for any fever caused by an infection and relax to see if it eases the feelings.
How is the MS hug treated?
Although uncomfortable, the MS Hug often passes without needing treatment. There are things you can do which may make a difference to the sensations. However, if the MS hug is long lasting or very painful, there are drugs which may help you.
How can I manage the MS hug myself?
There is plenty you can try to see if it helps. Everyone is different so you may need to try a range of different options before you find what works for you. You may need to do several at once for the best effect.
Tight clothing. Some people find that creating an understandable cause for the feeling of tightness tricks the brain into accepting the feeling more. You could try a close fitting top, scarf or bandage around the chest, a glove on the affected hand or socks or boots if it’s your feet or legs that are affected. Applying pressure with the flat of your hand can also work well.
Loose clothing. Some people find that loose, lightweight clothing is best.
If the MS hug is long lasting or very painful, you could ask about drug treatments. These fall into two categories depending on whether the feelings are due to nerve pain or spasms in the small intercostal muscles between your ribs. If the symptoms are part of a relapse, then steroids may be prescribed too.
Nerve pain, also known as neuropathic pain, includes unusual feelings like pressure, tightness, aching or stabbing. These altered sensations are known as dysaesthesia and the MS hug is often treated in the same way as other dysaesthesia symptoms. NICE (National Institute for Health and Care Excellence) has recommended that amitriptyline, duloxetine, gabapentin or pregabalin (Lyrica) are tried first.
If the feeling is due to spasms, the first drugs to try are usually baclofen or gabapentin but there are other options if these are not working well enough.
Often your neurologist and MS nurse will work with you to manage your MS hug symptoms. In some parts of the UK, you may be referred to a pain clinic with its own specialist team of doctors and nurses.
Your health professionals should review your treatment regularly and suggest alternatives if something is not working well. Sometimes a combination of drugs works best.
Jawahar R, et al. A systematic review of pharmacological pain management in multiple sclerosis. Drugs 2013;73(15):1711-1722. Summary (link is external)
