Over 50% of patients diagnosed with multiple sclerosis cite pain as one of their primary symptoms. Pain in MS can be difficult to care for and treat, especially because chronic pain can be debilitating and unending for those who struggle with it. With MS primarily affecting the central nervous system, this pain can often be difficult to recognize and treat. The most common symptoms include headaches, burning sensations, back pain (particularly in the lower back), and tonic spasms. These symptoms vary, however, depending on the type of pain the patient has. In order to understand how to manage pain as a symptom of MS, it is important to first understand the different types of pain that patients have.
One type of pain in MS is neurogenic pain or nerve pain. Neurogenic pain is due to the damage of the nerves in the central nervous system (made up of the spinal cord and brain), which causes the nerves to be inflamed or dysfunctioning. This type of pain is characterized by burning or tingling sensations, numbness, spasms, Lhermitte’s sign (a shock-like feeling affecting the legs and spine that occurs when the neck is flexed), and optic neuritis, and trigeminal neuralgia (sharp sensations on the face).
Most neurogenic pain cannot be treated through the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as common over-the-counter painkillers. This is because the nerves are the cause of pain, and painkillers do not help in soothing the stimulated nerves. Instead, patients can use medications to calm the nerves, such as antiepileptic and antispasticity drugs, as well as topical medications like lidocaine for the tingling or burning symptoms. There are many different routes to managing neurogenic pain, and doctors can help patients find a medication or method that works best for them.
The other type of pain in MS is nociceptive pain or musculoskeletal pain. This pain can be less in intensity (compared to neurogenic pain) but can last longer and have long-term effects on the body. It is mostly associated with living with MS and its effects and can be caused by anything that warrants a painful response. Common symptoms of this type of pain are lower back pains, muscle or joint pains, stiff joints, and spasms.
Nociceptive pain can be treated using NSAIDs, as most pain is receptive to the anti-inflammatory nature of painkillers and similar NSAIDs. Patients can also use antidepressant medications (to shift the perception of pain and improve mood) and antispasticity medication for their spasms. Nociceptive pain can also be treated through non-pharmaceutical methods including tai chi, yoga, acupuncture, massage, and others. Physiotherapy can also be helpful in aiding posture and stance, thereby making sure no further pain is caused by a certain posture.
Pain management in MS is highlighted by self-wellness, and by practicing wellness habits. These can include (but are not limited to), journaling exercise, using heat and cold to relieve pain and tension, sleeping, and being mindful. Regardless of the types of pain, these habits have been found to decrease the patient’s pain, as well as an overall improvement in pain management. By understanding the different types of pain and their solutions, MS pain can be successfully managed in a way that doesn’t hinder the patient from living their life.
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