51 msfocusmagazine.org are characterized by brief, almost stereotypic, events occurring frequentlyand often triggered by movement or sensory stimuli. In many instances they are caused by the faulty transmission of nerve impulses at sites of previous disease activity. While paroxysomal pain is annoying, it does not represent an exacerbation. Trigeminal neuralgia and Lhermitte’s sign are two of the most common types of paroxysmal pain syndromes. Trigeminal neuralgia aﬀects the trigeminal nerve, which carries sensation from the face to the brain. Even mild stimulation of your face, such as brushing teeth or putting on makeup, can trigger a jolt of excruciating pain. Trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain. Lhermitte’s sign is indicated by a stabbing, electric-shock-like sensation running from the back of the head and down the spine, which is brought on by bending the neck forward. These paroxysmal attacks typicallyrespond to low doses of anticonvulsant medications, such as carbamazepine and valproic acid, and usually remit after several weeks or months. Soft collars are often used in patients who experience Lhermitte’s sign. Neuropathic pain is probably the most commonly reported pain syndrome among people with MS. It often is the result of nerve damage caused by MS lesions. The eﬀect of nerve damage is a change in nerve function both at the site of the injury and areas around it. Approximately 50 percent of MS patients who report pain experience neuropathic pain. This type of pain is often described as a shooting or burning pain. While neuropathic pain can go away on its own, it is often chronic. In many cases neuropathic pain can be unrelenting and severe; in other instances, it comes and goes. Neuropathic pain can be very difficult to treat. Anticonvulsants, antidepressants, antispasmodics, capsaicin cream, and cannabinoids are all viable treatment options. Patientsoftenhavetotrydiﬀerentcombinations of products to ﬁnd the one that works best for them. Opioid pain medications do not generally oﬀer patients with neuropathic pain much relief. No two patients with MS show symptoms in the exact same way, and the same can be said for MS-related pain. There are diﬀerent types of pain and diﬀerent types of treatments. All patients with multiple sclerosis should discuss pain with their physicians at each visit. Patients should particularly make their physicians aware if pain changes or if new pain occurs.