Medications used for MS pain
Pain management is a two-step process: First, careful assessment to select appropriate medications;
second, adding mental health support and/or complementary therapies such as yoga and meditation.
The chart below lists some examples of drugs that may be used for different types of MS pain.
Type of Pain
Neurogenic pain (nerve pain), chronic or
episodic, such as burning, tingling, pins and
needles in the extremities, often at night.
Class of Medication (with generic examples)
Antidepressant agents: Tricyclic (amitriptyline,
nortriptyline, desipramine…); SSNRI (duloxetine,
venlafaxine…)
Intermittent, paroxysmal neurogenic pain
that is sharp, searing stabbing pain such as
trigeminal neuralgia and painful tonic spasms.
Continuous, steady neurogenic pain such as
painful extremity dysesthesias
Mild/moderate nerve pain, such as
dysesthesias.
Painful spasms
Musculoskeletal pain/joint pain
Moderate/severe pain; opioids for when non-opioids don’t work.
Antiepileptic agents: carbamazepine, oxcarbazepine,
lamotrigine, gabapentin, pregabalin, valproic acid,
phenytoin
Antispasticity agents: baclofen
Benzodiazepine agents: clonazepam (avoid in
combination with opioids)
Weak opioid agent: tramadol
Antidepressant agents: amitriptyline, duloxetine
Antiepileptic agents: gabapentin, pregabalin,
lamotrigine, carbamazepine, topiramate, levetiracetam
Weak opioid: tramadol
Strong opioids: buprenorphine, fentanyl, oxycodone
Antiepileptic agents: gabapentin, pregabalin,
Topical agents: capsaicin, lidocaine, diclofenac,
methylsalicylate
Antispasticity agents: baclofen, tizanidine, diazepam,
dantrium, botulinum-A
Nonsteroidal Anti-inflammatories (NSAIDS):
ibuprofen, naproxen sodium, celecoxib, aspirin
Analgesic: acetaminophen
Opioid Agents
Weak opioid: tramadol
Strong opioids: buprenorphine, fentanyl, oxycodone,
methadone, hydrocodone, morphine sulfate
Chart courtesy of Heidi Maloni, PhD, ANP- BC, Clinical Nursing Director, MS Center of Excellence East at the VA
Medical Center, Washington, DC.
