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Multiple Sclerosis: Sensory Symptoms and Pain

Multiple sclerosis (MS) can cause many different kinds of sensory changes, most of which are annoying and uncomfortable but not serious. In other words, you may hate them but they don’t indicate big-time disease progression, and they generally aren’t incapacitating.

For example, numbness and pins and needles in the arms or legs are both very common. From the doctor’s perspective, there’s no need to treat these symptoms unless they’re particularly bothersome, in which case a short course of high-dose corticosteroids may be helpful.

Pain deserves prompt attention because it can be distracting, debilitating, and depressing — and who needs that? For years, people were told that MS doesn’t cause pain. Well, it does, and it can have a significant impact on your quality of life. At least 50 percent of folks with MS experience pain at one time or another. Pain in MS can be divided into the following two main types:

  • Primary pain: This pain, which is also called neuropathic pain, is caused by inflammation and demyelination along the sensory pathways in the brain and spinal cord. In other words, this kind of pain has a neurologic basis.

  • Secondary pain: This type of pain occurs as an indirect result of other problems. For example, if your posture has changed as a result of weakness or stiffness in your arms or legs, you may begin to experience pain in your back or hips.

MS and primary pain

Several different types of pain can occur as a result of damage to the nerves:

  • Dysesthesias, the most common pain in MS, are achy, burning sensations that generally occur in your arms, legs, or trunk. The “MS hug” is a tight, bandlike sensation around your chest or mid-section.

  • Trigeminal neuralgia is a severe, lancing or stabbing pain in the face (in the area of the trigeminal nerve).

  • Lhermitte’s sign is an electrical shock-like or buzzing sensation that some people with MS experience. This sensation travels down their spine and into their legs when they bend their head forward.

Medications are the first-line treatment for neuropathic pain. The treatment process requires somewhat of a try-and-see approach, because pain is an individual experience and people respond differently to the medications. The usual strategy is to start at a low dose of one medication and work up to an effective level.

MS and secondary pain

Secondary pain is pretty common in MS because weakness, spasticity, and other MS symptoms can affect your whole musculoskeletal system. Your neck, lower back, and knees are the usual suspects when it comes to problems.

The best way to address this kind of pain is to try and prevent it in the first place with the right types of exercise, careful attention to your posture while walking and sitting, and optimal use of the correct mobility aids (when needed). Your rehabilitation team can recommend strategies to help maintain your comfort and flexibility.

If and when you develop secondary problems with your neck, back, or knees, make sure that the healthcare professional treating you is aware of your MS and its relationship to the problems you’re having. This is definitely a time when it’s helpful to get the professionals on your team to talk to one another.

For example, an orthopedist consulted about a knee or back problem may recommend certain types of weight-bearing exercise on the assumption that your difficulties are the result of weak muscles when, in reality, the underlying problem has to do with impaired nerve impulses to those muscles.

Many people with neck or back pain consult a chiropractor. Even though the data from studies on chiropractic therapy suggest that it may benefit lower back pain, you need to consult with your neurologist before beginning treatment. Because of your MS, manipulations of your spine may not be in your best interest.

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