What's the best treatment for MS pain?

MS is a complex condition that can cause pain in a variety of ways. The 2 main types of pain caused by MS are nerve pain and musculoskeletal pain. Both types of pain may be either acute (short-term) or chronic (long-term). We will learn more about how each type of pain is caused and how this pain can be relieved.

Musculoskeletal pain is stiffness or pain in the muscles, bones, or joints. This type of pain may be caused by muscle spasms (uncontrollable muscle contractions – a symptom of MS), by prolonged sitting or lying due to mobility problems, or by changing the way you move or hold yourself to make up for weakness or coordination problems caused by MS.

Musculoskeletal pain can be treated with a combination of pain relievers (such as ibuprofen) and therapy to correct the source of the pain. When the pain is related to muscle spasms, medications such as baclofen and tizanidine are used to relieve the spasms and, as a result, to help with pain relief. Physiotherapy and stretching can be used to strengthen muscles, improve flexibility, and help prevent further injury and pain. Massages may also help by relieving muscle tightness and stiffness.

Nerve pain is caused by MS-related nerve damage. Healthy nerves conduct sensations of pain and touch. When the nerves become damaged, they can transmit abnormal messages, leading to unusual sensations and pain. Nerve pain can include prickling, burning, tingling, or aching sensations. Nerve damage can also turn normal sensations, such as the feeling of fabric touching the skin, into painful ones. There are many different types of nerve pain, including trigeminal neuralgia (sharp, severe pains in the face), Lhermitte's sign (stabbing pain down the neck and back that happens when you flex your neck), and dysesthesias (painful burning, aching or prickling sensations).

Nerve pain is often treated with anticonvulsants (such as gabapentin, carbamazepine, or phenytoin) or antidepressants (such as amitriptyline, imipramine, or desipramine). These medications are used because they work on the nerves to modify the pain sensations. Pressure stockings or gloves are sometimes used to treat nerve pain. They can help make the pain feel more like pressure.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Controlling-Pain

MS pain: Facts and myths

When it comes to MS pain, how can you separate fact from fiction? Here are a few common facts and myths about pain in MS.

Myth: It's all in your head! MS doesn't cause pain.
Fact: It was once believed that MS itself did not cause pain. Now we know that MS pain is very common. In fact, over half of people with MS suffer from pain caused by the condition.

Myth: If the pain is getting worse, then the MS is getting worse too.
Fact: Increasing pain is not necessarily a sign of that your MS is getting worse. A study on MS and pain did not find a relationship between pain and the length of time a person had MS, or the amount of disability caused by MS.

Myth: You should not use opioid pain relievers (such as morphine) because you will become addicted to them.
Fact: Addiction is very rare in people without a history of drug addiction who are using opioids (such as morphine) for pain relief. If strong pain relievers such as opioids are needed to relieve your pain, it is better to use these medications than to leave the pain untreated. Untreated pain can spiral out of control, leading to fear, worsening pain, and limitation of activities.

Myth: All pain is bad.
Fact: Pain evolved to help warn people of injuries and illness. Some pain can be good. For example, the pain of a sprained ankle prevents you from walking on it and causing further injury. This type of pain helps the body avoid further injury or warns it that it needs to heal. Other pain, such as the nerve pain caused by MS, is not helpful, and should be relieved with appropriate therapy.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Controlling-Pain

Taking control of your pain

Everyone has a right to good pain control. Many people with MS live with pain that could be effectively relieved. Sometimes this is because their existing treatment is not working, because they or their health professionals are not aware of all treatment methods, or because they don't know how to bring up the topic with their doctor. How can you make sure that you get effective pain relief?

Communication is key to successful pain control. Pain is subjective – it can't be measured with a blood test or a scan. Plus, the severity and types of pain vary widely between people with MS. This means that your own description of the pain will be a critical tool for the health professionals involved in your care. They will use your own evaluation of the pain to help choose and adjust treatment.

The "PQRST" is a popular way of measuring and describing pain:

  • P = Provoking and palliating factors: What makes the pain better (palliating) or worse (provoking)?
  • Q = Quality: What does the pain feel like? (e.g., burning, stinging, aching, pounding)
  • R = Radiation: Does the pain "move" to other areas of the body?
  • S = Severity: How bad is the pain? Usually you'll be asked to rate the pain on a scale of zero to 10, with zero being "no pain" and 10 being "the worst pain you can imagine".
  • T = Time: When did the pain start? Does it come and go? If so, how often do you have pain and how long does it last?

This method helps doctors understand what your pain is like. This will assist them in the next step of pain control, which is identifying the cause of the pain. This is important, since treatment options often depend on what is causing the pain. The doctor will also try to figure out whether the pain is being caused by MS, or by another medical condition (since people with MS can still get other conditions, such as arthritis). Using the PQRST will also help you track your pain over time to see how well treatments are working. Sometimes, it is not possible to completely relieve all pain, and it may be necessary to agree on an "acceptable" level of pain relief to try for.

Depending on the cause of your pain, you will probably need a combination of medication and non-medication treatment options to get effective pain relief. Medication options include:

  • painkillers, such as acetaminophen, ibuprofen, codeine, or morphine
  • medications for nerve pain, such as amitriptyline and gabapentin
  • medications for spasticity, such as baclofen and tizanidine

Non-medication options include hot or cold packs, physiotherapy, stretching, yoga, or acupuncture.

There is also a mental and emotional side to pain. Many people also find that doing things they enjoy helps take their mind off of the pain. Meditation, humour, and relaxation techniques can also help with pain relief. It's also important to have an emotional support network of friends, family, and other people with MS.

If you are not satisfied with your level of pain relief, or if you would like to try another pain control option, speak with your doctor, pharmacist, or nurse. Only you know how the pain feels, so only you can judge whether the pain relief plan is working.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Controlling-Pain

New research into MS pain

Medical research is leading to a better understanding of MS pain and opening up new treatment avenues.

Researchers are putting together a more complete picture of how the body perceives and deals with pain. For example, we now know more about sodium channels, which are "gateways" between the inside and outside of nerve cells. Sodium channels are involved in helping pain signals travel along pathways through the body. If sodium channels are not working properly, inappropriate pain signals may be sent.

Although it was believed that there was only one kind of sodium channel, new studies show there are as many as 10 different kinds. This opens up the possibility of developing new drugs to act on the different sodium channels and help with MS pain. Another interesting area of research is medications that regulate pain by turning genes in nerve cells on or off.

You may have heard about people smoking marijuana to relieve MS pain and symptoms. Is there any evidence that it works, and is it legal? Studies have shown that cannabis oil (which comes from the marijuana plant) and pills of THC (the main active ingredient of marijuana) produce some improvement in pain. However, smoking marijuana is not generally recommended as a medical treatment because it may be even more harmful than smoking cigarettes. But it can be used as a "last resort" for people whose pain cannot be controlled by other means.

In Canada, people with MS can apply for special permission to use marijuana legally for persistent, severe pain related to MS. Your doctor will need to be involved in the process, and you will need to use a government-approved supply of marijuana. To find out more about MS pain control options or research, speak with your doctor or pharmacist.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/MS-Controlling-Pain