50 msfocusmagazine.org Medicine & Research Multiple Sclerosis and Pain By Ellen Whipple, Pharm.D. Historically speaking, pain was not always thought to be a symptom of multiple sclerosis. Over time, clinicians have come to realize that it is not onlyan MS symptom, but also in some cases, a key symptom. Data suggests that 25-60 percent of people with MS experience pain, and that, as a symptom, pain is frequently underdiagnosed and undertreated. One survey found that 38 percent of patientswho reported MS-related pain actually received treatment for their symptoms, and only 39 percent of patients said that their pain was adequately controlled. Certain factors, such as age at onset, length of time with MS, or degree of disability, do not distinguish between those with pain, and those without. Because pain can affect activities of daily living, such as work, recreation, mood, and enjoyment of life, it is important that patients who experience pain report it to their physicians. Why does pain occur in MS? MS-related pain varies from patient to patient. “Chronic and achy” pain is commonly the result of fatigued muscles, especiallywhen they are compensating for muscles that have been weakened from the MS disease process. “Electrical and stabbing” pain occurs from faulty nerve signals emanating from the nerves due to MS lesions in the brain and spinal cord. What are the Common Types of Pain? And How Do Their Treatments Vary? Musculoskeletal pain occurs in approxi- mately 20 percent of patients with MS. It is because of muscularweakness, spasticity, and imbalance. It is most often seen in the hips, legs, and arms, especially when muscles, tendons, and ligaments remain immobile for extended periods of time. Back pain may occurbecause of improperseating orincorrect posturewhilewalking. Contractures associated with weakness and spasticity can be painful. Muscular spasms or cramps (called flexor spasms) can be severe and discomfiting. Leg spasms, for example, often occur during sleep. The treatments of musculoskeletal pain vary depending on the cause. Nonsteroidal anti-inflammatory drugs and traditional pain medications can be used to treat musculo- skeletal pain. When the pain is related to spasticity, antispasmodic medications can also be useful. Sometimes assistive devices can help with musculoskeletal pain when the painisbecauseofimproperseatingorincorrect posture. Sensory or paroxysmal pain occurs in 5 to 10 percent of MS patients. This type of pain is theresultofdemyelinatinglesions.Symptoms RX Update