For help communicating with your doctor, call us
at 1-800-344-4867. We can offer communication
strategies and resources on pain to share with your
health-care provider.
How to make it go away
Pain management in MS should be comprehensive and multimodal. In other words, you and
your health-care providers should explore everything until something works. Although there
have been no big breakthroughs in recent years,
there are more drugs to try and a better understanding of the positive role of complementary
approaches.
“We’ll keep making educated guesses on therapies
until the pain stops,” said Anthony Reder, MD,
professor of Neurology at the University of Chicago Medical Center.
Neurogenic, or nerve, pain is often treated with
anticonvulsants. Acute nerve pain can include
trigeminal neuralgia, a searing facial pain that can
occur with MS; Lhermitte’s sign, a shocking sensation that runs from the back of the head down the
spine when the neck is bent; and stabbing eye pain
possibly caused by optic neuritis. These “
paroxysmal” pains tend to come and go independent of
the course of the MS.
Anticonvulsants and/or antidepressants may also
improve the odd and painful sensations known
as dysesthesias. One example is called the “MS
hug, a terrible term for something that creates the
brutal feel of constriction,” said Dr. Green. Her
patients sometimes tell her that when they eat,
they hurt, because of that so-called “hug.”
Anticonvulsants and antidepressants may also calm
the burning, aching, numbing, prickling or “pins
and needles” sensations called paresthesias. Paresthesias may worsen after surgery or broken bones;
and chronically numb areas should be inspected
frequently for infection and injury.
From people with MS: A
spectrum of pain strategies
by Marcella Durand
In May, the Society asked its Facebook followers what they use for pain besides prescription
medications. The responses revealed a wealth of
creative spirit .
Strategies ranged from alternative medications, such as cannabis in various forms and
alcohol—to methods including acupuncture,
chiropractic treatment and massage. Many also
mentioned heating pads, icing painful areas and
TENS (transcutaneous electrical nerve stimulation) units.
Activities to relieve pain were even more
various. People cited meditation, visualization,
music, sleep, prayer, cuddling with pets, laughter, sex, and positive thinking. Helpful exercise
regimens included yoga, stretching, swimming,
weight-lifting, and walking. Others believe
managing their diet reduced pain, either by following a gluten-free regime or simply by eating
healthier foods.
Complementary treatments include wearing a
pressure stocking or glove, warm compresses, and
over-the-counter pain relievers.
There’s no hard evidence yet that low-dose nal-trexone (LDN), which is FDA approved for drug
and alcohol dependence, eases MS pain, said Dr.
Green. In fact, she is concerned that people may use
it instead of standard disease-modifying therapies.
However, a Society-funded study in 2010 suggested
that LDN helps mental health and pain control. Dr.
Reder said there are hints that LDN may work by
boosting responses to the brain’s natural feel-good
chemicals. Further research is recommended.
