In part 1, I went over three common types of pain in MS: trigeminal neuralgia, or facial pain caused by damage to one or more of the three branches of the trigeminal nerve in your head; eye pain, which is caused by inflammation of the optic nerve that usually affects one eye at a time; and MS hug, a squeezing sensation around the ribcage.
The generosity of multiple sclerosis is infinite, so of course there's more to add about MS pain. I must approach this with my sarcastic sense of humor because I feel like I’m enrolled in the MS rewards program, where I get all perks I didn't sign up for.
4. Lhermitte’s sign is a sudden electric shock that runs down the neck and spine when you bend your neck forward, and could certainly freak you out the first time it happens.
I was officially diagnosed with MS 7 years ago. But when I told one of my MS-specialized neurologists that I remembered experiencing Lhermitte’s sign when I was 19, he put the stamp on it as my first official symptom of multiple sclerosis. That means that instead of 7 years, I’ve been living with MS for at least 26 years. Shocker!
5. Pruritisis the constant, chronic itching of the skin. Because of its neuropathic origin, topical creams or dermatological treatments usually don't work. It could be treated with anti-seizure medications or some antidepressants. It's believed to be a form of dysesthesia or abnormal sensations, similar to pins and needles or burning skin.
My experience with pruritis is a little different from other stories I've heard from other MS folks. Instead of being one of my first unexplainable symptoms, it’s one of my current symptoms. Particularly when I’m ready to go to sleep lying in bed, as I try to unwind and relax, my nervous system has a hard time calming down. My nerves refuse to give in, and I’m itching in all different areas of my body, making falling asleep quite a ritual.
Since it takes my system time to get the memo “we’re getting ready to go to sleep,” I'm currently taking an anti-seizure medication under the supervision of my neurologist, to help with hypersensitivity and itching on my skin. Although I still have itching at night, it slowly subsides as the medication sets in. This medication also helps with another form of dysesthesia I live with: burning skin.
6. Paroxysmal spasms, or sudden attacks or episodes of painful tightening of the muscles, come and go throughout the day unexpectedly. They commonly take place on the face, arms, and legs. MS can damage the nerves that affect your muscles, and this can trigger pain. These shooting pains can be disruptive when you’re in the middle of an activity and can interfere with your daily tasks.
Having experienced this sudden onset of pain, I can tell you that this can really stop you on your tracks. It just comes out of nowhere and it's usually intense. Fortunately, if you will, it lasts only a few seconds or a few minutes and it goes away the same way it came.
Who hasn't experienced a tic on the lip or eyelid? This is an example of paroxysmal spasms on a minor scale. Probably not painful, but certainly very annoying.
I'm not sure if everybody feels the same way, but I feel like my MS is very active. I have everything in the book and more. Although my MRIs are stable and I don't show any active lesions, all the symptoms are there daily.
Managing the Different Types of MS Pain
Unfortunately, there’s no magic formula to treat pain in MS. It could be a frustrating time while you pin down what works for you. Not only that, but MS is dynamic and versatile. Symptoms change over time, whether they subside, improve, or worsen.
Anti-seizure medications, antidepressants, opioids, painkillers, steroids, and topical ointments are commonly used as a way of treatment. Some more successful than others, depending on the real cause of the pain. But it's a matter of trial and error when it comes to treating MS pain.
Pain can also be addressed without the use of drugs. Physical and occupational therapy, meditation, yoga, tai chi, water exercises, and acupuncture can be used as complementary or alternative therapies.
It's important to discuss your pain with your doctor to pinpoint what the real source of your pain could be, instead of piling up on drugs or over-the-counter medications that could potentially not resolve it and could have long-term side effects.
For example, if your pain is related to weakness or changes in gait, then maybe the right treatment would be to go to physical therapy to address the weakness. If the pain comes from spasticity, then medication and stretching exercises would be appropriate, as opposed to just taking muscle relaxant drugs.
Neuropathic pain usually doesn't respond well to strong pain medications. This is where the anti-seizures or antidepressant medications come into place. According to the National MS Society, these medications are not approved by the FDA as a treatment for pain in MS, but are used as off-label in MS.
It's also worth mentioning that your emotional state, anxiety, or depression could cause physical pain. Mental health goes hand in hand with your physical health. Many people think that these are two separate things, but, in reality, they're not. Your thoughts, your feelings, your emotions are as important as your physical condition, and each affects the other.
In conclusion, MS pain is real. Whether it's neuropathic or musculoskeletal, we experience pain while living with multiple sclerosis. As debilitating as it could be, there’re still ways to treat it. A multidisciplinary approach can help you manage pain more effectively, using a combination of medication and alternative therapies. Just remember to always consult with your doctor before you start any new treatment and keep and open communication with your doctor.
To connect with other people living with multiple sclerosis, join our MS Facebook Support Group.
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