Pain and MS
“MS doesn’t cause pain.”
As surprising as this statement sounds, decades ago it was the standard medical stance. We now recognize that many people with MS (multiple sclerosis) have pain, and we are testing different treatment techniques to help relieve the pain.
While there is a tendency to blame any symptom that a person with MS has on the MS itself, it is important to partner with your neurologist in figuring out what the cause of your pain is in you.
MS affects the central nervous system (CNS), and so any part of the brain, optic nerves or spinal cord may be the source of MS pain. Demyelination (loss of myelin, the covering of the nerves) in the optic nerve, called optic neuritis, is usually a painful loss of vision. The “MS hug” is another example of a painful condition caused by demyelination, but this time in the spinal cord; people with MS may feel a constricting feeling around their chest or abdomen – this is classically described as feeling like a “boa constrictor.” Trigeminal neuralgia is a painful condition where there is electrical shooting pain in the face.
Often people with MS have pain that is indirectly caused by demyelination, and instead is caused by stiffness in the muscles or abnormal walking, that may place pressure on a joint. What makes this different from pain directly caused by MS demyelination, is that the immune cells involved in MS do not target the joints or the muscles, and instead the MS affects movement, and abnormal movement causes an uncomfortable, painful sensation.
Other causes of MS pain include syndromes associated with MS, but not necessarily caused by the MS process itself. For example, restless leg syndrome (RLS) is when there is an uncomfortable sensation causing an itching to move your legs while at rest. RLS is seen in many people without MS, especially those with low iron levels.
After figuring out the cause of your pain, the next step is to work with your neurologist to tailor an individualized treatment plan for you. While medication may be used to treat the pain, there are many other modalities as well. For example, we often use yoga, Tai Chi, physical/occupational therapy, herbal treatments, mindful meditation and breathing exercises.
Pain in MS should be approached in a two-step manner:
- Determine the specific cause of the pain
- Tailor the treatment approach to the particular source of pain