It has been established that there is pain in MS. I have talked about neuropathic pain and musculoskeletal pain, which is generally considered secondary pain. Now it is time to talk about tertiary pain. Tertiary pain can be broadly defined as the social, vocational and psychological complications brought on by the primary and secondary symptoms.

It is important to remember that these problems affect people in different ways, and for some they will always remain very mild.

Tertiary pain can be something as simple as bruises, cuts, and scrapes cause by an unstable balance or an awkward gait. Even trying to fight MS by using the known disease-modifying drugs sometimes causes tertiary pain. It may begin with painful injections that leave deep bruises, skin problems and flu-like symptoms. Or, it may be more serious problems like blood abnormalities and liver dysfunction. In addition, Novantrone® is known to cause heart problems and a higher risk of leukemia. Tysabri® may cause a life-threatening brain virus. These problems are rare, but MSers who choose each treatment must be aware of the possibilities.

Every time an MSer feels a new pain, the question arises -- Is this an MS pain? Sometimes the answer is unknown, awaiting further information. While the pain is being identified, sometimes over a long time, there is often a period of fear and stress, reminiscent of the state of limbo experienced while awaiting the original diagnosis. When a current symptom seems to become more intense, the question is -- Is this a new exacerbation? Again, the answer must wait for 24 hours when it can be determined to be an exacerbation.

MS treatment is focused on physical symptoms, but psychological, emotional and social symptoms can be devastating and painful as well. Tertiary pain largely fits into those categories which sometimes involve physical pain as well.

Pain certainly affects our quality of life. Quality of life is what makes life worth living. It is difficult to measure subjective factors, but I think tertiary symptoms take a bigger bite out of quality of life than most other MS symptoms. Let's look at some examples:

Job/Career
For many people, their quality of life centers around what they do, whether that means a career, volunteer work, enjoying family, or anything else they may choose. When a chronic disease like MS enters the picture, things often change. Most MSers experience fatigue, and fatigue is the symptom that causes most MSers to leave their jobs. Other symptoms may also conflict with the ability to perform certain job functions.

Sadly, a lack of awareness on the part of employers is a reason for some retirements. Often an accommodation could lengthen the working lifespan, and sometimes no accommodation is needed. Too often, MSers are pressured to take early retirement because of lack of understanding.  I read about a woman who was diagnosed and immediately handed her retirement papers. No wonder there is such personal conflict about what information should be shared and when.