There is pain in multiple sclerosis, with several categories that can be acute or chronic. My last article discussed neuropathic pain.  Today, I am going to talk about details specific to musculoskeletal pain.

Our musculoskeletal system -- bones, muscles, connective tissues -- provides our bodies with stability and movement. Musculoskeletal pain, also known as nociceptive pain, can seriously affect our well-being. Nociceptors are free nerve endings that detect stimuli and interpret them as pain. Nociceptors, protected by myelin, are in all types of body tissue except the brain itself. Neuropathic pain is caused by nervous system lesions while musculoskeletal pain is caused by actual tissue damage detected by the nociceptors.

Musculoskeletal pain is not caused by MS, but by MS symptoms. Therefore, musculoskeletal pains are defined as secondary pain. It is often made worse by our inactivity, immobility, spasticity, and posture problems. That is, simply having multiple sclerosis makes MS musculoskeletal pains worse.

Musculoskeletal pain, like neuropathic pain, presents itself in many different ways. These pains generally have more casual names than those used to identify pains caused by the nervous system. Here are some common musculoskeletal pains experienced by MSers:

Joint Pain
Pain in the joints, most likely hips, ankles, knees, elbows and maybe even the neck, is caused by balance and gait problems as well as ataxia and immobility, and often by spasticity.

Ligaments
Pain in muscles, tendons and ligaments are made worse by limbs remaining in fixed positions, which causes tension to build up.

Stiffness
Stiffness in the legs, arms, hips, and back is due to immobility and spasticity.

Back Pain
Back pain is prevalent in many conditions, including MS, and there are many causes. Back, hip, and base-of-the-spine pain is caused by an unsteady gait, immobility or pressure caused by that immobility, the MS hug, sitting for extended periods in a wheelchair, spasticity, or the incorrect use of mobility aids. Because MSers often have trouble with comfort and must struggle to position themselves or compensate for gait and balance problems, back pain may be amplified.

Spasticity
Tonic or flexor spasms cause a limb to contract, or bend, towards the body. The result is the effected limb having a constant cramp or dull ache. Muscle cramps or spasms can be made worse by inactivity or postural problems. Conversely, an extensor spasm causes a limb, usually a leg, to stiffen, and the person is unable to bend that joint, resulting in difficulty sitting or transferring from one location to another such as from a wheelchair to a bed or car.

In addition, spasms, which can be painful and distressful in themselves, can cause problems with general mobility and cause breathing difficulties. When one muscle has a spasm, it can trigger another to spasm as well. After a period of time with chronic spasms, muscles become very weak causing even further pain.

It seems the simple tightening of or tremor in a muscle leads to all kinds of problems, from low-grade pain, to irritation, or even to extreme pain. Maybe it's not so simple after all.