Types of pain assoiciated with multiple sclerosis
Trigeminal neuralgia
xcruciating, sharp,
shock-like pain in cheek and forehead that can be triggered by speaking, touch, or facial movements, usually lasting seconds to several minutes but sometimes repeated throughout the day; involves trigeminal nerve in the jaw, cheek, and face. Recommended treatments include carbamazepine, gabapentin, baclofen, lamotrigine, phenytoin, or misoprostal. Surgery may be considered if these
drugs are ineffective.
Lhermitte's sign
sensation of an
electric shock through the body initiated by a forward movement of the head. This kind of pain has been reported by 25% of MS patients and can be traced to an active cervical cord lesion. A soft
neck brace can help people with this condition to avoid tilting their heads forward.
Optic neuritis
Optic neuritis is a common early symptom of
MS, involving eye pain and temporary loss of vision. Both oral and intravenous (IV)
methylprednisolone are sometimes used, though there is currently no consensus on which treatment is most effective.
Paroxysmal limb pain
painful burning, aching, or itching, lasting seconds to a few minutes, most often in the extremities and legs. This kind of intense, fleeting pain responds to treatment with carbmezepine, amitriptyline, clonazepam, diazepam, gabapentin, or alternating hot and cold compresses.
Dysesthetic extremity pain
chronic sensations of burning, tingling, tightness, or pins-and-needles; dull warm aching; worse at night and after exercise, aggravated by temperature and weather. This chronic neuropathic type of pain is seen in people with MS who have low levels of disability. It has been shown to respond to the
tricyclic antidepressants amitryline, imiprimine, desipramine, or nortrytyline. Applications of capsaicin can also be helpful. For patients experiencing bands of pain around the torso or limbs, gabapentin may be used.
Tonic spasms
brief intense muscle cramps or
spasms. Possible medications include carbamazepine, gabapentin, phenytoin, baclofen, and acetazolamide.
Headaches
migraine, cluster, tension. There is some evidence that migraine
headaches occur more frequently in patients with MS, though more research is needed to substantiate this finding. Usual headache treatments are used.
Chronic backache
musculosketal pain resulting from weak muscles, immobility, incorrect use of mobility devices, and spasticity. A physical therapist can recommend exercises to strengthen muscles and appropriate methods to compensate for gait problems. Patients using mobility devices such as canes or limb braces can learn how to minimize stress to the spine and back muscles with help from an occupational therapist.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be used for temporary relief from chronic back pain.
