The Link Between Multiple Sclerosis and Pain

Inside the types of pain that may occur with MS and which interventions may be helpful.

Pain may not be the first symptom you think of when you or a loved one is diagnosed with multiple sclerosis. According to the latest information from the National Multiple Sclerosis Society (NMSS), close to 1 million people in the United States today are living with the chronic disease. MS occurs when the immune system attacks the central nervous system, including the brain, optic nerve, and spinal cord, leading to an array of physical, psychological, and emotional symptoms—including significant pain.

The MS—PAIN Connection

Many people with MS are diagnosed in their 20s or 30s, but it’s possible for the disease to begin as early as childhood, or as late as middle age and beyond, with more females than males affected. And although the cause of MS isn’t fully understood, it’s believed that the Epstein-Barr virus, smoking, childhood obesity, and low Vitamin D levels can be risk factors in people who have a genetic predisposition for the disease.

“Pain is a fairly common symptom of MS,” says Julie Fiol, RN, director of MS Information and Resources for NMSS. She explains that, while the full prevalence of pain in people with MS has not been adequately captured, some studies believe that pain affects as many as 60 to 80% of individuals with the disease.

“Pain is a very personal experience and can have a significant impact on quality of life—affecting emotional well-being and possibly leading to social isolation and increased pain,” she adds.

If you have MS and this scenario sounds all too familiar, you probably know first-hand the extent of the impact, as well as the fact that the pain can be very difficult to treat. “Pain puts you at increased risk of mood disorders, mobility problems, and employment loss. Uncontrolled pain can also worsen other MS symptoms,” Fiol stresses. This makes MS and pain a vicious cycle that can be hard to break.

Close to 1 million people in the United States are living with MS and they typically use 9 different strategies to manage their pain. (Image: iStock)

Central Neuropathic Pain

The pain that is experienced by most people with multiple sclerosis can be classified into two types—central neuropathic pain and musculoskeletal pain.

Central neuropathic pain occurs as a result of damage to the nerves that is caused by the disease (the immune system response) itself.  “All nerves in the central nervous system are covered by a coating called myelin. The myelin coating around each nerve fiber serves as insulation, much like the plastic coating on an electrical wire. This helps to ensure the efficient transmission of nerve impulses [messages] between the brain and other parts of the body,” explains Fiol. When the immune system attacks the central nervous system in relation to MS, these nerve fibers can be damaged and lesions form in the affected area. This damage prevents messages to the brain and back from being communicated properly, or in some cases, stops their transmission completely. This error in communication can lead to many pain-related symptoms, including:

  • headache
  • painful sensations that feel like burning, prickling, jolting, ice, stabbing (particularly in the face), or electric shock (running from the top of the spine to the limbs)
  • trigeminal neuralgia—a stabbing pain in the face or jaw area
  • muscle stiffness and muscle spasms
  • squeezing feeling around the middle of the body
  • unexplained itchy feeling.

Exactly where the lesion occurs in the central nervous system will often correlate with the type of symptoms. “For example, some back pain in MS can be traced back to a lesion in the spinal cord. Headache, facial pain, and extremity pain can also be linked back to a lesion in the central nervous system,” says Fiol.

Musculoskeletal pain can occur as a result of changes that the disease causes to the body overall. In other words, muscle weakness, muscle deconditioning, immobility, and additional stress on bones, muscles, and joints that are caused by MS can ultimately lead to the pain. For example, if the condition has changed body positioning and walking stride, it may also be straining the back or neck, leading to pain in those areas.

Spasticity—the continuous contracting of muscles—may also present with MS, resulting in stiffness or tightness that can interfere with movement and speech.

 

How to Manage Pain as a Symptom of Multiple Sclerosis

If MS pain is severe, persistent and/or debilitating, medications may provide some relief. Musculoskeletal pain, for instance, may be relieved by over-the-counter analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). However, pain caused by MS nerve damage can be much harder to treat.

“Studies show that pain control is one of the most common uses of medications in MS symptom management,” says Fiol. Yet there are no medications approved by the US Food and Drug Administration (FDA) specifically to treat MS-related pain at this time. Therefore, medications, including certain anti-depressants and anti-seizure drugs, are often prescribed by doctors off-label for MS pain. In addition, a variety of alternative treatments and lifestyle modifications may be tried to find the best overall treatment plan. See below.

According to Fiol, “A study published in the Disability and Health Journal found that, on average, people living with MS and pain use nine different strategies to manage their pain [which can involve a combination of medications and alternative treatments], with very few reporting effective relief of that pain despite those strategies. The interventions reported to be most effective in that study were hypnosis, nerve blocks, and cannabis."

The Promise of Cannabis

In fact, a report from the American Academy of Neurology (AAN) looking at complementary and alternative approaches to treat MS finds that oral cannabis extract and synthetic cannabis are believed to be effective in treating self-reported spasticity and pain in MS.

While the FDA has not approved these forms of cannabis for use in MS, the majority of states in the US have legalized the substance, making it more accessible. However, since the quality and testing of cannabis is not regulated at the federal level, patients need to be cautious of what they are getting and where they get it. Therefore, always talk to your healthcare provider before trying any type of cannabis to treat MS symptoms.

The Need for More Research

With so few options available to manage MS pain, more research is being conducted to study psychological interventions that might make a difference. For instance, data is still emerging on the potential promise of mindfulness meditation, notes Fiol.

If you have MS and are living with intermittent or persistent pain that interferes with your daily activities, it’s important to partner with your healthcare provider to understand the root of your pain and to find the best combination of strategies that will work for your specific situation.

Updated on: 03/12/20
Continue Reading:
Living with the Pain of Multiple Sclerosis
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