The pain of multiple sclerosis is quite variable and an individualized problem depending upon the area of the lesions in the brain and spinal cord which are caused by the MS. For the most part, pain from multiple sclerosis can not be effectively treated with aspirin, ibuprofen and or other common over-the-counter pain relievers and medications. Because multiple sclerosis originates from the central nervous system it makes pain control more difficult than if it originated from the joint or muscle.
In many cases the treatment chosen for pain management includes the use of anticonvulsant medications which address neurological pain such as Neurontin and Tegretol. The interesting thing about treatment with these medications is that physicians are not sure how they work, for either seizures or for pain. Since the FDA has not officially approved these particular anticonvulsants for the treatment of pain they are being used “off label”. This means that although the drug is approved by the FDA for use in other disease situations, and the drug is believed to be safe, it has not been approved for the use of nerve pain. Interestingly though, Neurontin is prescribed five times more often for pain than it is for seizures.
In the vast majority of patients these medications do work but the side effects include sleepiness, grogginess or fatigue. And since patients with multiple sclerosis often fight fatigue as a symptom of their disease, the addition of this as a side effect only decreases their ability to live an active lifestyle.
One of the goals of pain medication for multiple sclerosis is to find the correct medication which will treat the pain without adding side effects. This is often a trial and error period where the individual to be started on the lowest dose possible and increased until the individual is comfortable without side effects. If one medication doesn’t work then another one will be tried.
According to the Institute of Medicine of the National Academies of Medicine, pain that affects people with multiple sclerosis can be divided into four broad categories. The first category is chronic pain which results from abnormal function of the brain and spinal cord. This type of pain is sometimes referred to as nerve pain. It is stabbing and can cause spasms and severe pain that usually lasts no more than two minutes at a time.
The next type of pain is called acute pain which results from an active inflammatory process. Pain secondary to increased muscle tone as a result of the multiple sclerosis will include cramps and spasticity which causes stiffness and tightening of the muscles. The fourth broad category of pain is chronic or recurrent nonspecific nature. This pain may include neck or back pain that as a result of muscle weakness or myofascial pain secondary to disuse and spasticity.
Other medications which are commonly used to treat pain in patients who have multiple sclerosis will include antidepressants such as the tricyclic antidepressants, selective serotonin norepinephrine re-uptake inhibitors and anti-anxiety medications, such as Valium and Klonopin.
For the most part, medications can be found which will successfully treat pain in patients with multiple sclerosis. However between 1 and 2% of patients will have refractory pain which is extremely hard to manage. This type of pain in intractable or uncontrollable. In these cases patients have been involved in clinical trials to evaluate the efficacy of medications in the treatment of pain.
One possibility being investigated at this time is Botox. Botox is the anti-wrinkle injection that was made popular by Park Avenue socialites, but is also a important modality in the treatment of spasticity in patients who have spinal cord injuries. Botox acts to temporarily paralyze the nerve or muscle and could potentially be used to treat spastic pain in patients who have multiple sclerosis.
Another pain control mechanism that is currently being studied is hypnosis. Researchers believe that with hypnosis they may be able to block or at least reduce the interpretation of pain in the peripheral body. And because this treatment doesn’t have the obvious medication side effects that can potentially be used with individuals who are currently on a large medication regimen treating a variety of conditions.
If you suffer from pain secondary to multiple sclerosis it’s important to recognize that you will have options. Work with your healthcare practitioner in order to find the medication the combination that works best for your particular disease.
National Multiple Sclerosis Society: Pain
US Department of Veterans Affairs: http://www.va.gov/
Expert Review of Neurotherapeutics: Pharmacological treatment of Pain in Multiple sclerosis
Cleveland Clinic: Multiple Sclerosis and Pain
Multiple Sclerosis society: Treating and managing Pain
Multiple Sclerosis International Federation: Pain