A to Z of MS Pain

More than half of all people with multiple sclerosis will experience pain at some stage.

A number of multiple scerlosis symptoms that may be classed as pain, including:

• Altered sensations (dysaesthesia)
  

  This can include sensations such as:

• numbness
• tingling
• pins and needles
• burning sensations
• sudden stabbing pains
• chronic gnawing pains
• changes in sensation, eg very sensitive patches of skin
• feelings of constriction, tightness or being squeezed around the chest
• Trigeminal neuralgia, an intense painful sensations in the face

No two people will experience pain in the same way; it is very subjective and is best described by the person experiencing it.

Types of pain

There are two broadly recognised types of pain in MS:

Neuropathic pain

Also known as nerve pain, this is thought that this arises as a direct result of the damaged to the covering of nerves interfering with the normal transmission of information to the brain. However, the origin of most nerve pain is not fully understood.

Musculoskeletal pain

Also known as nociceptive pain. Nociceptors are pain receptors found throughout the body that respond to injury and inflammation. They send messages to the brain that are perceived as pain, usually in the joints or muscles. This type of pain is not directly related to MS, but may be worsened by it; for example, musculoskeletal pain can arise as the result of spasms or abnormal pressure on the muscles and joints due to changes in posture, typically in the back or hips.

Management of pain

The management of pain in multiple sclerosis is not always easy and may not be completely successful. Some types of pain will never go away entirely. The body can adapt to tolerate a certain level of day-to-day pain and the person with MS may not recognise the pain as a symptom after a while. Treatment depends largely on the cause of the pain and so a proper assessment in necessary to determine whether the pain is nerve pain, muscle pain or might be due to causes other than MS.

The aim of treatment if the pain cannot be eradicated, is to manage the level of pain so that the individual can carry out normal day-to-day living; therefore it is important to be open to a range of possible treatment options, which may include drugs or non-drug treatments such as physiotherapy.

In March 2010 NICE (National Institute for Health and Clinical Excellence) issued clinical guidelines for neuropathic pain. This indicated amitriptyline or pregabalin (Lyrica) as a first-line treatment. If amitriptyline is effective but side effects are a problem, oral imipramine (Tofranil) or nortriptyline are suggested as alternatives.

Should the chosen drug not be effective, doctors should try the other one, either on its own or in combination with the original drug. If this is also unsuccessful, the person should be referred to a pain specialist for further treatment.

References

Beard S, Hunn A, Wright J.
Treatments of spasticity and pain in multiple sclerosis: a systematic review.
HTA 2003:7(40):1-124.
abstract

Osterberg A, Boivie J, Thuomas K-A.
Central pain in multiple sclerosis - prevelance and clinical characteristics.
Eur J Pain 2005;9(5):531-542.
abstract

National Institute for Health and Clinical Excellence.
Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings.
London: NICE; 2010.
Download from the NICE website

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