Pain is not a symptom of multiple sclerosis, right? Wrong. That has got to be one of the more frustrating myths for those of us living with MS. Pain in MS can show up as neuropathic pain or musculoskeletal pain. A particularly disturbing type of pain in MS that can sometimes feel like a boa constrictor is squeezing the breath out of you has commonly been called the MS hug.
Symptoms of MS stem from damaged myelin (the coating that protects nerves) that impacts proper nerve function and health. Neuropathic pain can be caused by disrupted nerve signals. Symptoms of neuropathic pain may include abnormal sensations — tingling, numbness, skin crawling, itching, burning, or prickly sensations — which are called paresthesias. These can be acute or chronic, severe or mild, painful or just plain weird.
In MS, disrupted nerve signals and overly sensitive motor neurons can lead to spasticity and/or painful muscle spams. Musculoskeletal pain caused by muscle spams, muscle weakness, physical stress on joints, or poor coordination are commonly associated with MS. These pains may be acute or chronic. When they show up suddenly, last only a brief period of time, and disappear rapidly, they are called paroxysmal symptoms. Paroxysmal symptoms may occur once or repeat over a longer period of time. If they show up repeatedly, that might be a sign of an MS relapse.
Treatment for MS pain
Common pharmacological management of neuropathic pain in MS includes anti-seizure drugs, corticosteroids, anti-spasticity drugs, or benzodiazepines. Antidepressant agents and opioids may help to modulate the experience of pain. Musculoskeletal pain may respond to physical therapy, stretching, spasticity medications, and conventional painkillers such as ibuprofen.
The MS hug: Definition and causes
The MS hug is a highly unpleasant, painful banding sensation that occurs anywhere around the torso. Some people in the online community have referred to the MS hug as the “Squeeze o’ Death.” Symptoms of the MS hug can show up anywhere on the torso, on one side or the other, or circling all the way around the body. The pain can range from mild numbness or tingling to excruciatingly sharp pain or pressure. Each person’s experience is unique and may even differ from one episode to the next.
Explanations of the cause of the MS hug vary. The pain may be neuropathic in origin such as dysesthesia (which is basically a really bad paresthesia). The pain might stem from extreme spasticity in the intercostal muscles of the rib cage. There are three layers of muscle fibers in the intercostal muscles that connect the ribs and assist with breathing. If these muscles are involved, symptoms may include chest tightening, difficulty breathing, and limited mobility.
What to do if you have the MS hug
If you suddenly experience chest pain or asthma-like symptoms, or you feel like a big snake is trying to squeeze the life out of you, don’t assume that it is your MS. Seek medical attention immediately. There may be another cause of your symptoms or pain. It’s better to err on the side of caution when your health is concerned.
The MS hug could be part of a relapse that needs steroids, or it could be a symptom of a pseudoexacerbation brought on by heat, stress, or fatigue. In the latter case, the symptoms should go away when the trigger for the pseudoexacerbation has resolved. In either circumstance, focusing on stress-reduction techniques may help to keep the hug from getting worse.
Treatment options for the MS hug
Although I have never personally experienced the MS hug, here are some suggested treatments and strategies that may help you if you do:
- Treatment for neuropathic pain to reduce paresthesias
Anti-spasticity medications to reduce muscle tension
Antidepressants, opioids, or non-opioid pain medication to modify the pain response
Non-steroidal anti-inflammatory medication to reduce inflammation
Corticosteroids to treat a relapse and reduce inflammation
Analgesic creams containing capsaicin or menthol (a word of caution: Test the cream on a small area of skin first to make sure that it doesn’t worsen the sensation.)
Herbal therapies, such as marijuana, may reduce spasticity (another word of caution: Marijuana possession is illegal in some states and side effects may affect cognition.)
Stress-reduction techniques, such as deep breathing, progressive relaxation, meditation, or creative visualizations
Movement therapies, such as gentle stretching, massage, or yoga
Body cooling, if the MS hug is triggered by heat sensitivity
Applied heat to relax and soothe tight, sore muscles and potentially to reduce spasticity
Reduction of potential triggers for muscle spasms or cramps, such as dehydration, caffeine consumption, or vitamin/mineral deficiency