Symptom Management

PT for Pain Management in MS

By Stefanie DiCarrado and Stephanie Muth
Pain is a common occurrence in everyone’s life. However, people with multiple sclerosis have an even greater chance of developing postural related pain, general muscle pain, headache, or neuropathic pain. Recent articles published in the Frontiers of Neurology found 50-70 percent of persons with MS report some form of ongoing pain, with about 10 percent reporting pain as their primary symptom.

Pain is not the same for everyone; it is a subjective experience that each person may describe differently. This is because pain results from our brain interpreting signals it receives from the body. A lot of different factors can affect this interpretation, which means each person can experience painful sensations differently. Some people may interpret pain at a higher or lower intensity than others, while some may experience painful sensations without any actual tissue injury.

Causes and manifestations

Pain sensations can have different causes and manifest in several different ways. Postural- related pain can result from accumulated tissue microtrauma occurring when we stand, sit, move, or lie down in less than optimal positions for long periods of time. The pain tends to be focused generally in the neck, back, and limbs. If you frequently experience muscle spasms, you may feel pain with them because the spasms can compress nearby blood vessels, causing what is called ischemic pain. The spasticity can cause microscopic muscle injury resembling that of muscle strains, which may also be a source of the pain.

Headaches can occur from poor posture, muscle spasms, or can be induced by certain medications. Neuropathic pain can occur from damage to either the peripheral nerves or from within the central nervous system’s sensory pathway and is frequently related to the degenerative effects of MS itself. This can cause pain that can be felt in various places throughout your body and is often described as burning, electric, or shooting in nature. Perhaps the most common neuropathic pain experienced by persons with MS is called dysaesthetic pain, described as a constant burning, tingling, or throbbing generally felt in the legs. Other types of neuropathic pain include trigeminal neuralgia (pain felt in the face), glossopharyngeal neuralgia (pain felt in the throat), and Lhermitte's sign (pain felt down the back associated with neck movement). Although not necessarily considered neuropathic pain, individuals with optic neuritis may experience dull pain around or in their eyes.

Pain can be acute, chronic, or a mix of both. Acute pain, according to Cleveland Clinic, is pain that lasts less than six months and is due to a specific injury or tissue damage. Chronic pain, is classified as pain that exists for longer than six months, which can persist even after your original injury has healed. It may be caused by structures in your body sending incorrect pain signals to the brain or by other sensations being erroneously interpreted as pain.

The formal definition of pain, as provided by the International Association for the Study of Pain, is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” This means your body can become overly sensitive to any sensations and interpret them as painful. This sensation is especially prevalent in individuals experiencing emotional stress and/or depression.

PTs key to pain management

You do not have suffer through your pain alone; anyone experiencing pain should seek help from their healthcare team. Physical therapists are key members of this team and can be very effective in helping you manage your pain by optimizing how you move and function, preventing and rehabilitating injuries, and teaching you techniques to improve how you feel. How they help you to manage your pain will depend on the type of pain you are having. This will be discerned through focused discussion about your pain, lifestyle, and goals.

Questions about your pain will investigate exactly where your pain is located, how long have you had your pain, which factors make your pain better or worse, and explore the role your pain plays in your day-to-day life. You will also be asked to discuss what your daily life entails. It is important for the PT to understand the kinds of tasks you must perform at work, at home, and during recreational activities. It will also be important to share stressors that may be making your pain worse. For example, if you have recently started a new job that has higher demands than you are accustomed to, both the job tasks as well as the stress of higher expectations could be contributing to your pain. Your therapist will also want to understand what health and wellness goals you have related to managing your pain.

Next, your therapist will perform a physical examination to assess your muscles, nerves, skin, heart, and lungs, as well as observe how you perform various tasks. Once all assessments are completed, your PT and you will create a plan of care that best fits both of your goals.

Breaking the pain cycle

If your pain is because of an acute tissue injury, such as a trauma to a ligament or muscle, your plan of care will likely include a combination of manual therapy and specific exercises to address the injured and surrounding tissues. Your therapist will teach you various methods on how to move and perform daily tasks in a way that will help decrease your pain and prevent further tissue injury.

If you are having pain specifically because of nerve damage, your therapist will work with you to determine whether the damage is due to an orthopedic issue, directly related to your MS, or is a result of some other neurologic issue. The treatment will depend on a variety of factors including the source and type of pain as well as how long you have been experiencing the pain. Treatments include but are not limited to manual therapy, therapeutic exercise to relax muscles that are tight or in spasm, movement retraining, or various forms of electrical stimulation.

If you have been dealing with your pain for a long time, your treatment plan will look a little bit different. Chronic pain can be very stressful. Additionally, stress can make chronic pain worse, which can create more stress. This cycle is known as the stress/pain cycle.

Physical therapists can work with you and other members of your healthcare team to help you break this cycle. Movement and aerobic exercise are important elements in the plan of care to manage chronic pain. Your therapist will likely introduce movements gradually and other stimuli that have been causing your pain to help you work through the experience in a positive and supportive manner. You will also likely be encouraged to begin a program of regular aerobic exercise, as this may improve symptoms related to your pain and improve your overall health.

Pain is a complicated phenomenon that is experienced differently by different people. Successful management of pain, especially chronic pain, usually requires a team-based approach and ongoing communication between you and the members of your healthcare team. While certain types of pain may require medication, physical therapy can often reduce or even eliminate the need for pain medications. Working with a physical therapist that has experience with different types of pain, including pain related to MS, can help you manage your pain, improve how you perform tasks that are important to you, and improve your overall health and well-being.