Pain is a common symptom of multiple sclerosis that affects up to 86 percent of the 2.3 million people diagnosed with MS worldwide. For years doctors denied that MS was associated with pain—however, recent reports support the patient view that MS can indeed be painful.
Types of MS pain
The pain associated with MS can be classified into four major categories: continuous central neuropathic pain, intermittent central neuropathic pain, musculoskeletal pain, and mixed neuropathic and non-neuropathic pain. Neuropathic pain results from abnormal function of the nervous system. Musculoskeletal pain is pain that affects bones, muscles, ligaments and tendons.
How common is musculoskeletal pain in MS?
A recent study investigated the severity and prevalence of musculoskeletal pain in MS patients in the Mazandaran Province of north Iran. Among 115 participants (76.5 percent female; mean age 30.4±5.8 years; mean disease duration 26.3±24.3 months), 87.8 percent were experiencing pain at the time of the study.
Lower limb pain, especially in the knees, is most common.
The most common locations for musculoskeletal pain reported were the knee (in 55.7 percent of study participants), wrist (43.5 percent), and neck (41.7 percent). In the 12 months prior to the study, significant numbers of the participants experienced chronic upper limb pain (60.9 percent), lower limb pain (64.3 percent), and backache (46.1 percent).
Upper back and neck pain are common in early stages of the disease.
MS patients reported mild to moderate pain, with more than half (53.9 percent) reporting that musculoskeletal pain had interfered with daily functioning, at least for a time. Upper back and neck pain were more common in patients who’d had MS for a shorter period of time, while knee pain was more common in patients with MS for a longer period of time.
Five times more women with MS have upper back pain.
Women experienced higher prevalence of shoulder, upper back, and ankle pain. The risk of upper back pain was 5.16 times higher in women than men, while ankle pain was 2.19 times higher. There was no significant gender difference in neck, wrist, back, hip, or knee pain.
Longer disease duration is associated with higher pain levels.
On a pain scale of 0-10, the average pain severity in this study was 3.85±1.65 (3.96±1.73 for females; 3.48±1.31 for males). Patients with MS for more than two years experienced significantly greater pain levels (4.55±1.29 vs 3.48±1.71). There was no statistically significant gender difference in average pain scores.
MS patients rated their worst pain as 5.73±2.12 (5.84±2.24 for females; 5.37±1.64 for males). Those patients with longer disease duration (more than two years) reported significantly higher worst pain levels (6.60±1.85 vs. 5.26±2.12).
Pain is very common in MS.
In this study, pain was a very common experience in patients with MS that was not related to age or gender. Pain was more common in the lower limbs, especially in the knees; while in the majority of cases, more than one limb was involved. In females, the prevalence of pain in the shoulders, upper back, and ankle was higher compared to males. Also, neck and upper-back pain were found in the early stages of the disease.
As I live with both MS and RA, I have experienced pain in and around several joints in my body. It is easy to blame RA for all joint pain. But sometimes pain can be caused by osteoarthritis, which I also have in the knees. I have noticed that if I focus on deep stretches and reducing spasticity in my legs, my knee pain is reduced. We experience nothing in isolation. Everything is connected somehow.
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ShayestehAzar M, Kariminasab MH, Saravi MS, et al. A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple Sclerosis Patients; a Cross-Sectional Study. Arch Bone Jt Surg. 2015 Apr;3(2):114-8.
(photo credit: aleks)