MS and Pain - It's REAL and you are not a wimp!
Treatment The preferred drug for treating acute pain syndromes in MS is anticonvulsant medication. Carbamazepine (Tegretol) is the drug of choice. Gabapentin (Neurontin) and phenytoin (Dilantin) are also used. These medications block abnormal nerve conduction at the demyelinated site. These drugs can have side effects, and may also cause the worsening of other MS symptoms such as weakness or tremor because they block nerve conduction. Capsaicin, a topical cream made from hot chili peppers, is also used to treat Trigeminal Neuralgia.
Sub acute Pain Sub acute pain can also be caused by demyelination, or from a secondary source, such as the swelling of the nerve. The most common sub acute syndrome is optic neuritis. Optic Neuritis is an aching, throbbing pain around or behind the eye and is provoked by eye movement. It is often the first symptom of MS. Optic Neuritis usually resolves in 7-10 days.
Treatment Treatment of Optic Neuritis is generally with corticosteriods like Solumedrol or Prednisone to reduce optic nerve swelling.
Chronic Pain Chronic neurogenic pain is the most common, and the most intractable of the pain syndromes in MS. Chronic pain syndromes make up 50 to 80% of all pain experienced in MS. Chronic pain syndromes include parenthesis and dysesthesias.
Paresthesias include pins and needles, tingling, shivering, and burning pains, feeling of pressure, and areas of skin with heightened sensitivity.
Dysesthesias include burning, aching or girdling around the body.
Treatment
Treatment for neuropathic pain is with antidepressants called tricyclics. Amitriptyline (Elavil) has been the most commonly used tricyclic, but newer antidepressants such as bupropion (Wellbutrin) are replacing the older tricyclics because of reduced side effects.
If these medications do not work anticonvulsants, narcotics or the anti-spasticity drug baclofen can be tried. Combinations of these drug therapies can also be tried, although the risk of side effects rises with increased medication.
In addition to the drug therapies, other therapies such as physiotherapy, relaxation, meditation, deep breathing, yoga, chi gung, biofeedback, massage, chiropractic, hydrotherapy, acupuncture, etc. can help to alleviate and control chronic pain. Transcutaneous nerve stimulation (TENS), which is actually a variant of acupuncture, is also sometimes used to provide relief.
Other MS Pain Other MS pain is often not directly related to demyelination and neuropathic pain. Chronic pain syndromes such as backache and leg spasms affect many people with MS. Reduced mobility, poor posture in walking and sitting can cause lower back pain. Spasms (intense cramping)
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