Multiple Sclerosis and Pain
Multiple sclerosis (MS) damages nerve fibers in the central nervous system (CNS). Over time, it leads to various problems and pain such as muscle weakness, loss of balance, numbness, and vision problems. Several medications have been found to slow the disease’s progression and can limit nerve damage.
What is multiple sclerosis (MS)?
Multiple sclerosis (MS) is an autoimmune disease in which your immune system starts attacking its own healthy cells. During this attack, the immune system also affects cells in the myelin, the protective coating surrounding nerves in the brain and spinal cord.
Damage to the myelin sheath disrupts nerve signals emitting from your brain to other parts of your body. This leads to the symptoms which constitute Multiple Sclerosis.
What are the types of Multiple Sclerosis?
There are 4 types.
- Clinically isolated syndrome (CIS)
- Relapsing-remitting MS (RRMS)
- Primary progressive MS (PPMS)
- Secondary progressive MS (SPMS)
Causes of Multiple Sclerosis
Doctors and scientists still don’t know the exact causes of multiple sclerosis. Further research is needed to pinpoint the exact cause of MS. However, there are the following factors that can potentially trigger Multiple Sclerosis:
- Exposure to pathogens such as certain bacteria and viruses
- Living surroundings
- Problems in the immune system
Pain associated with Multiple Sclerosis
Some people with MS may have pain during the course of the disease while others may not have it. Multiple Sclerosis causes damage to the nerve fibers. as stated above. Due to this phenomenon, short-circuiting of the nerves occurs which leads to pain.
This pain can affect different places in your body. You may feel burns and aches in your feet, legs, and arms. You may also feel tightness around your abdomen and chest that gets worse at night. This is called “MS Hug”. It can make you feel uncomfortable while getting dressed.
You may feel the pain in your face, in your toes, in your neck, in your back and bones, and your muscles. This pain can be acute and short term or it can progress to chronic pain and keep on disturbing for a long time.
Other signs and symptoms
Here are some other common signs and symptoms of MS:
- Loss of balance
- Muscle weakness
- Muscle spasms
- Numbness or tingling sensation in limbs
- Vision problems: These are usually the first signs to appear.
There is no single specific test to accurately diagnose Multiple Sclerosis. A doctor will assess your signs and symptoms carefully. He will take a detailed history and will perform a general physical examination.
He will advise various tests to rule out other conditions. Some of the main tests that are helpful are:
- MRI (Magnetic Resonance Imaging) Brain
- Spinal tap for CSF examination
- Evoked potential tests
- Nerve conduction Studies
Management of Multiple Sclerosis and pain associated with it
As there is no permanent cure for MS. Treatment focuses on relieving the associated symptoms and enabling normal life activities. Depending upon the severity of your pain, your doctor may recommend over-the-counter painkillers such as naproxen and ibuprofen. If the pain is in muscles, he may recommend some muscle relaxers such as baclofen, tizanidine, or diazepam. In painful situations, he can recommend spinal infusion pumps of muscle relaxers or painkillers. Sometimes, doctors even use Botox shots to temporarily paralyze a muscle or nerve. The purpose of this is to ease the crippling pain. Physical therapy may also be needed.
So, a summary of the management of pain associated with multiple sclerosis is:
- Over-the-counter (OTC) painkillers such as naproxen and ibuprofen
- Muscle relaxers such as diazepam and tizanidine
- Botox shots
- Range-of-motion exercises
For the management of other symptoms of Multiple Sclerosis, a comprehensive treatment plan consists of the following:
- Disease-modifying therapies (DMTs)
- Relapse management medications such as corticosteroids
- Mental health counseling
- Social support system
The Takeaway Message:
Multiple Sclerosis damages the nerves in the brain and spinal cord. It has a wide range of signs and symptoms. As there is no permanent cure for it, treatment aims to improve the symptoms. Painkillers and muscle relaxers are used to relieve the pain while a comprehensive treatment plan is needed for relieving other symptoms.
If you or someone among your loved ones is suffering from Multiple Sclerosis, it is always the best idea to consult your doctor. He will formulate a personalized treatment plan for you. Social support is integral for continuing with normal routine activities.
- Nick, S. T., Roberts, C., Billiodeaux, S., Davis, D. E., Zamanifekri, B., Sahraian, M. A., Alekseeva, N., Munjampalli, S., Roberts, J., & Minagar, A. (2012). Multiple sclerosis and pain. Neurological research, 34(9), 829–841. https://doi.org/10.1179/1743132812Y.0000000082
- Solaro, C., Trabucco, E., & Messmer Uccelli, M. (2013). Pain and multiple sclerosis: pathophysiology and treatment. Current neurology and neuroscience reports, 13(1), 320. https://doi.org/10.1007/s11910-012-0320-5
- O’Connor, A. B., Schwid, S. R., Herrmann, D. N., Markman, J. D., & Dworkin, R. H. (2008). Pain associated with multiple sclerosis: systematic review and proposed classification. Pain, 137(1), 96–111. https://doi.org/10.1016/j.pain.2007.08.024
- Pöllmann, W., & Feneberg, W. (2008). Current management of pain associated with multiple sclerosis. CNS drugs, 22(4), 291–324. https://doi.org/10.2165/00023210-200822040-00003
- Wright L. J. (2012). Identifying and treating pain caused by MS. The Journal of clinical psychiatry, 73(7), e23. https://doi.org/10.4088/JCP.11093nr1c
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