Pain and MS: Musculoskeletal Pain

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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.

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

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.

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.

Urinary Tract Infection
Bladder problems and incontinence, besides being a major inconvenience, may lead to repeated urinary tract infections, especially when a catheter is required. Most catheter-associated infections can be prevented with the right management techniques.

Immobility and inactivity, common in MS because of weakness,fatigue, and paralysis, lead to osteoporosis. Therefore, MSers, especially those of us in wheelchairs who do not have the option of weight-bearing exercise, have a greater risk of losing more bone density and experiencing fractures. I know all too well about how osteoporosis can become severe.

Pressure Sores
Pressure sores, pressure ulcers, or bedsores are caused by the immobility and inactivity brought on by paralysis. Continuous pressure due to sitting or laying cuts off circulation and the tissue dies creating a pressure sore. I, personally, have not experienced this one and hope I don't. Active movement and adjusting to correct an uncomfortable position may prevent or reduce developing pressure sores, but at the same time mayresult in increased back pain.

Posture Problems
Paralysis can result in poor trunk control and posture, including foot alignment. This is very awkward and painful, and ,once again, the struggle to adjust posture leads to increased back pain.

Paroxysmal Pain
This type of pain begins with a sudden, acute neuropathic pain onset that lasts a short time, then fades into a possibly chronic residual or lingering pain after the episode. Each of these is described in detail in the neuropathic pain article. They include:

Trigeminal Neuralgia (TN) or Tic Doloreux
After the sudden intense attack, there remains an ache or pain in the mouth or jaw.

L'Hermitte's Sign
Following the initial electric-shock type sensation, breathing and comfort are often still affected.

Optic Neuritis
Although the intense pain may end before the vision problems correct themselves, discomfort may remain.

MS is a complex and confusing disease. Pains cause other pains, symptoms cause pain and make other symptoms worse resulting in even more pain -- a vicious circle in this cruel disease. Multiple sclerosis is not a painless disease. Our central nervous system generates pain and our musculoskeletal system is also hurting, but it does not end there.

Next time I'll talk about tertiary and other assorted pains.   If you have some pains you would like to share, please do.   I would like to hear about them.

Notes and Links: from WebMD
Explanation of nociception pain detection
Nociceptive and neuropathic pain