Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer
Question: What are the common types of pain in MS and are they treated differently?
Answer: When people with MS experience the onset of pain as a new symptom, they generally ask “why” and “can you make it go away?” I’ll try to address both questions. Although it may oversimplify the subject of pain in multiple sclerosis, I think it’s helpful to think of two major types of pain: neurogenic and nociceptive pain.
When an MS lesion in the brain or spinal cord is causing pain, this is referred to as neurogenic pain. It may be felt as shooting pain; burning, itching, or tingling; or even tightness and compression. Examples include the pain of optic neuritis; the painful itching or burning in a limb; the tightness and compression experienced from an “MS hug”; and the sudden pain with neck flexion due to cervical spinal cord lesions, known as “Lhermitte’s sign” or “Lhermitte’s phenomenon.” When treating neurogenic pain, the approach is often directed toward the use of anti-epilepsy medications such as gabapentin (Neurontin®), pregabalin (Lyrica®), and carbamazepam (Tegretol®).
Nociceptive pain is secondary discomfort in MS and it’s often musculoskeletal in origin. Examples include backaches, joint pain, and muscle cramps. Unlike neurogenic pain, nociceptive pain may respond to over-the-counter medications such as ibuprofen (Advil® and Motrin®), naproxen (Aleve®), and acetaminophen (Tylenol®). Nociceptive pain may also be treated with muscle relaxants such as tizanidine (Zanaflex®), or anti-spasticity agents, including baclofen. Sometimes a brief course of opioids is suggested for nociceptive pain as well. In addition, many types of pain respond to low doses of tricyclic antidepressant medications such as amitriptyline (Elavil®).
Some types of pain are more difficult to classify, including the increased frequency of headaches in people with MS. This could be neurogenic or nociceptive pain, depending on whether it is caused by an MS lesion, or if a secondary issue may be to blame – such as muscle strain, tension, or the side effect of a medication. Of course, headaches are common for people who have MS as well as for those who do not have MS – and in most cases – headaches in individuals with MS are almost always nociceptive.
Although pain can often be managed by your primary care physician or neurologist, when pain is severe and persistent, it’s often helpful to see a specialized pain-management physician. And always keep in mind the benefit of a wellness protocol, including judicious exercise, healthy eating, and attention to your mental health.
Please note that a physical therapist who is experienced with treating individuals with MS can be particularly helpful. Additional non-pharmaceutical (without medication) approaches include acupuncture, massage, and tai chi, among others.
To summarize, pain is common at some time or another in people with multiple sclerosis. However, in most instances, it can be managed successfully!
For more information, please visit MSAA’s website section focusing on pain.
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Barry A. Hendin, MD, is a neurologist and Director of the Arizona Integrated Neurology MS Center. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.
MSAA’s Ask the Expert series received a Merit Award from the 28th Annual Digital Health Awards!