Pain

Pain, although formerly dismissed as nonexistent in MS, is actually fairly common and has been shown in some studies to occur in as many as 40 percent of people with MS.  By taking a careful history and physical exam, a physician can help determine the cause of pain.  It is helpful to specifically define the cause of pain as either primary (due to the MS lesions and affecting mostly sensory pathways), or secondary (soft tissue or joint pain due to muscle weakness or spasticity).

Because of the number of locations where MS lesions can appear in the brain, it is common for the sensory systems to be affected.  The result of sensory involvement can be the loss of sensation in a particular area (patients describe numbness or decreased sensation) or can be heightened sensations that are not based in real or appropriate stimuli (burning or tingling feelings). The most troublesome of these heightened sensations is pain.

In addition to the distraction caused by these symptoms, sensory symptoms can affect a person’s ability to function.  For example, numbness in the feet can impact a person’s ability to feel when their feet hit the ground.  This lack of sensation can make walking less steady and confident.  Constant tingling in the hands can result in difficulties such as drop­ping objects or being unable to retrieve items from a pocket or purse.  Motor function, which is co­ordinated largely through sensory input, can be seriously impaired if sensation is impaired. Heat, overuse, and periods of exacerbation can increase these symp­toms, which in some patients are constantly present.  The treatment of pain deserves more attention than it traditionally gets, since it impacts patients’ quality of life, as well as their functional ability.

The causes of secondary pain in MS relate to the consequences of moving the body differently to accommodate the deficits caused by the MS.  MS secondary pain affects the muscles, bones, and connective tissue that are injured from overuse and incorrect use over time.  Secondary pain may involve the back, shoulders, hips, knees, or other areas.  The pain may be described by the patient as a dull aching, intermittent sharp pain, or constant, severe pain.  Evaluation, possibly including X-rays or other radiologic tests, is essential to identify the cause and appropriate treatments for secondary pain.

Sometimes people with more advanced MS experience pain due to swelling, or edema.  The swelling, which is caused when the muscles don’t contract enough to push out the liquids which gather due to gravity and lack of activity, can cause an aching sensation.

Treatment

MS pain is often treated effectively with medications that are used to treat epilepsy and depression.

There are many possible treatments for secondary pain including physical therapy to strengthen the surrounding area, anti-inflammatory medications, the use of assistive devices or equipment to take the emphasis off the affected area, or even surgery to repair areas of damage.  Pain management in these instances may involve a series of trials before it works completely, therefore patience and perserverence is essential.

The treatments for pain caused by swelling include intermittent elevation of the swol­len limb, stretching and exercise to force out the water, and diuretic medications if prescribed.