Pain and MS: Treatment

There is pain in MS. This series of articles has discussed that pain -- Neuropathic, Musculoskeletal, Tertiary, and MS Plus. Once the fact of pain has been accepted, the remaining question is how can that pain be stopped or reduced. Today, I am going to talk about traditional treatments for each of those pains discussed in the earlier posts.

The relationship between multiple sclerosis and pain has not been well documented, maybe because MS is such an individual disease and the subsequent pains are individual as well. Each pain may be acute or chronic, constant or intermittent, dull ache or sharp electric shock, and many of these pains are difficult to describe. Years ago, when MS was considered hysteria, pain was not acknowledged because no stimulus or source for that pain could be found. MS pain is a hidden symptom, but that does not make it hurt less. In modern days, there is more understanding of misdirected signals in the central nervous system.

I talk about these treatments in general terms. None of this is medical advice. When addressing MS pain, the first step is to talk with a neurologist and a pain management doctor. Pain management in MS is largely trial and error based on each patient's indications. Now, let's review pain and treatment.


Neuropathic pain

Neuropathic (nervous disease) pain occurs when the nervous system does not function properly and actually becomes the cause of pain. This is the most common kind of pain in MS. Here are the types of neuropathic pain I listed earlier along with a general indication of the type of treatment that is normally practiced or prescribed.

Dysesthesia, MS Hugs, Parasthesia, L'Hermitte's Sign and even Trigeminal Neuralgia are all types and intensities of dysesthesias. It is not unusual in MS and can be extremely painful. Regular pain-killers such as aspirin are often ineffective. Some MSers have prescriptions for cortico-steroids, but I didn't find any information one way or the other.

There are several things known to decrease the effects of dysesthesia. First is a group of tricyclic antidepressants.  Anti-depressants may relax the patient making an attack less likely.

Others medications prescribed include anti-epilepsy or anti-convulsants such as carbamazepine, diphenylhydantoin, and gabapentin. Also prescribed is capsaicin which is effective with arthritic types of conditions. Don't worry about the long names here. They are simply specific anti-epilepsy or anti-convulsant solutions sold under specific brand names that have been shown effective with dysesthesia.

Allodynia is usually treated using pulse therapy or anti-convusants.
Optic Neuritis generally just goes away after awhile. It may be treated using steroid medications to speed recovery.
Tonic Spasms are treated with prescription Baclofen or Zanaflex, or minerals calcium or magnesum. Nutritional supplements, while harmless, appear ineffective, but harmless.

Musculoskeletal pain

Musculoskeletal pain is actual tissue damage caused by the symptoms. This is secondary pain made worse by inactivity, immobility, spasticity, and just having MS. Musculoskeletal or secondary pain is quite common in MS. Treatment for this type of pain varies from muscle-relaxing drugs, standard anti-inflammatory painkillers such as ibuprofen and complementary therapies of exercise, yoga or tai chi. Here are the musculoskeletal pains and largely traditional treatments used to ease those pains.