Symptom Management

There are three distinct types of pain seen in people with MS. They are acute, paroxysmal, and chronic. Both acute and chronic pain can be either nerve or musculoskeletal in origin. Paroxysmal pain is generally related to nerve injury that occurs as a result of damage to the myelin sheath.

Musculoskeletal pain may be related to gait disturbances that individuals may not even realize they have. A physical therapy evaluation may target these disturbances and even small changes to conscious movement may improve this pain over time. Many people find that a massage therapist, chiropractor, or acupuncturist are beneficial in helping them to get control of musculoskeletal pain.

Nerve pain can require medication to calm it. People describe nerve pain as stabbing, searing, tingling, vicelike, and electrical. The primary meds used to treat nerve pain come from a class of drugs known as antiepileptics. In some cases, antidepressants may be used to increase nerve-quieting chemicals in the central nervous system. Both of these classes of medication have side-effects that include sleepiness, dry mouth, and constipation but these tend to disappear over time as the pain becomes better managed.

Medications such as codeine or hydrocodone were once used for MS nerve pain. We now know they are less effective than medications in the above-mentioned categories, and the antiepileptic and antidepressant medications work without the side-effect of rebound pain or dependence that opioids often produce.

Paroxysmal pain from nerve damage may not need to be treated with medications, as the pain is episodic and lasts for only a minute or two before calming. This, in some people, may be an indicator that a nerve is injured or damaged and once that injury calms or other nerve pathways have grown, the pain goes away.

For many with pain, eating an anti-inflammatory diet can help. (For more on anti-inflammatory eating, see the MS Focus publication Food to Fight MS.) Elimination of sugar that does not naturally occur in food can ramp down even very aggressive pain and make it more easily managed. People also report that with this sugar out of their systems, other MS symptoms tend to be less severe as well. A regular exercise program that both stretches and strengthens muscles goes a long way in improving muscle tone and reducing pain.

Not all pain experienced by people with a diagnosis of MS is actually caused by the condition.If you do work that is repetitive and have hand, wrist, arm, back, or neck pain, it may be related to your work or activity rather than the MS. Therefore, it is always important to have pain evaluated to determine the cause and develop a plan to manage it.


Understanding the Pain Scale

When you tell a medical professional about your pain, they will likely ask you to rate your pain on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain imaginable. Because there is no objective way to measure pain, it’s important for healthcare professionals to have this information.

However, pain is relative. If the worst pain a person ever had is a headache, a headache is the worst pain they can use as their point of comparison. So instead of thinking of pain in terms of how severe it is compared to other pain you’ve experienced, a more effective way to think of the pain scale is how it is affecting your ability to function.

Use the chart above as a reference for describing your pain levels when talking to your doctor.