Finally, some pain responds only to
narcotics. Dr. Reder prefers prescribing a
sustained low dose only. Narcotics only
blunt but don’t stop pain, he reasons, and
they can cause fatigue, constipation, bladder problems, a need for ever larger doses
and even addiction.
Devices called “dorsal column stimulators”
are still being evaluated for their use in
chronic pain and have not been studied in
MS neurogenic pain. Dr. Green suspects
the stimulation could backfire in people
with MS, making symptoms worse. She
advises a trial period first.
Musculoskeletal pain is not directly
caused by MS. In a way, it’s a side effect of
daily coping with disability. It stems from
inactivity, incorrect use of mobility aids,
or the struggle to balance and walk in the
face of MS symptoms. Examples include
chronic back pain from sitting for long periods;
hip trouble from limping; and even osteoarthritis
from a chronically hyperextended (the opposite
of bent) knee. “Plus people with MS tend to fall,
which leads to pain from fractures, sprains, and
dislocations,” said Dr. Green. Musculoskeletal
pain is treated with anti-inflammatory drugs,
physical therapy, heat (if well tolerated), massage
(if it is comforting), ultrasound, and treatment
for spasticity.
side effects, systemic effects and long-term effects
with data from controlled clinical trials in people
with MS, cannabis is not recommended by the
team. In Canada, however, a prescription canna-binoid mouth spray called Sativex is approved and
legal for treating nerve pain and spasticity.
Going green? The questions
about cannabis
The National MS Society has recently issued
new recommendations about the use of cannabis.
Although a medical team concluded that canna-
binoids (the active substances in cannabis) have
potential to manage MS pain and spasticity, there’s
no sign that they work better than existing treat-
ments. MS specialists worry about the impact on
cognition, mood and balance, which may already
be affected by MS. Until more is known about
Cannabinoids may be most promising as neuro-
protectors able to prevent nerve damage in the first
place. If that’s true, they could become a key part
of early MS treatment. Clinical trials of cannabi-
noids for nerve cell protection in MS are now in
progress in the United Kingdom.
Make it go away with
complementary approaches
Instead of being “the court of last resort,” complementary therapies are now integrated into pain
treatment plans from the start. They help people
cope with pain more effectively, often reducing
medication use and thus minimizing side effects
such as sedation or constipation.
