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.
Joint Pain or Ligaments
are treated with anti-inflammatory painkillers.
Back Pain responds to chiropractic therapy as well as standard painkillers.
Spasticity or Stiffness are often treated with prescription drugs like Baclofen or Zanaflex, or simply vitamins or minerals like calcium, D, or magnesium. Exercise reduces stiffness.
Urinary Tract Infection is often treated with something as simple as cranberry juice. It may respond better to antibiotics. There are several antibiotics that treat the infection or specific symptoms, most in tablet form, but some have unpleasant side effects.
Osteoporosis is commonly treated with bisphosphonate drugs such as Fosamax or Boneva given in pill form. If that doesn’t help, there is teriparatide such as Forteo given by injection or Calcitonin like Miacalcin, a nose spray.
Pressure Sores are best prevented by moving, changing position, or sitting on special cushions. After a pressure sore develops, it can be handled by staying off that area, changing position, and improving nutrition or hydration. If the sore is advanced, creams or antibiotics are used.
Posture Problems are corrected by physical or chiropractic therapy. Durable medical equipment such as custom chair backs and cushions are also helpful to ease pain and discomfort.
Paroxysmal Pain, Trigeminal Neuralgia, and L’Hermitte’s Sign are all treated by some form of anti-convulsants.
Optic Neuritis is treated with time or steroids.** Tertiary pain** Tertiary pain can be broadly defined as the social, vocational and psychological complications brought on by the primary and secondary symptoms. These pains do not generally have treatments. I think tertiary symptoms and pain adversely affect our quality of life more than any other MS symptoms and pains. However, for some of these, there are no real treatments for making the pain go away; instead, we must just learn to deal with it the best we can.
Job loss, personal relationships, and financial problems sometimes occur because of MS symptoms and sometimes because of lack of understanding or awareness.
Either way, it is not the MSer’s fault, but there is not an easy answer.
Dealing with these situations may require counseling.
Bruises, cuts, scrapes are treated with standard painkillers and topical creams.
Stress is managed with exercise such as yoga or tai chi. Other techniques are deep breathing and relaxation techniques.
Depression treatment includes anti-depressant drugs and counseling. ** MS Plus pain** I call this type of pain MS Plus because someone with MS may also have another condition or conditions added to that. Contracting one condition does not reduce the chance of contracting another. MS Plus refers to all of the conditions, disorders, and diseases that join MS to wreak havoc on our bodies, such as MS plus RA, MS plus osteoporosis, and as many of us experience, MS plus depression.
There is no one medication or treatment that can possibly address all of these combinations of disorders. Usually, the MS and the other disorder or disorders follow the treatment for that particular condition. There may be a time when more than one disorder follows the same treatment, so there can be overlaps. We must ensure that medication taken for MS does not conflict with medication taken for the other disorder or disorders. Alternative treatments Complementary and Alternative treatments are non-traditional interventions that try to reduce the pain. Approximately 50% - 75% of MSers use some form of CAM (complementary and alternative medications) either exclusively or alongside traditional treatments. It is important that MSers are aware of risks and benefits before jumping into these treatments. There is no cure for MS, regardless of claims. Even though a doctor’s prescription is often not required, it is highly recommended to inform our doctors to reduce chances of a conflict between pharmaceutical drugs. Traditional doctors are embracing these alternatives more than ever before.
There are so many alternatives, and some are accepted and even recommended by the traditional medical community. I will talk about them next week. Conclusion MS is often a hidden disease. Pain in MS is a hidden symptom. Hidden or not, whether it is a sudden, severe shock or burning sensation or a low grade, but long-term continuous ache, quality of life can be impacted. The right treatment is not always medication, and finding the best solution may take trial and error. Some MS pain can be relieved or reduced.
"The world is full of suffering, it is also full of overcoming it."
~ Helen Keller
Next I will talk about alternative therapies. Some of these are beneficial in deterring pain.
Notes and Links
Denise Coleman’s article on pain in MS