Overview
Pain syndromes are common in MS. There are different pain syndromes as noted below.
Trigeminal neuralgia
This is a stabbing pain in the face. It can occur as an initial symptom of MS. While it can be confused with dental pain, this pain is neuropathic (caused by damage to the trigeminal nerve) in origin. It can usually be treated with medications such as the anticonvulsants carbamazepine (Tegretol®), oxcarbazepine (Trileptal®) and lamotrigine (Lamictal®), Cytotec (misoprostol), Neurontin (gabapentin).
Lhermitte’s sign
This is a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward. Medications, including anticonvulsants, may be used to prevent the pain, or a soft collar may be used to limit neck flexion.
MS "Hug"
Burning, aching or “girdling” around the body. The technical name for them is dysesthesias (sometimes referred to as the "MS Hug") are all neurologic in origin. These painful sensations typically affect the legs and feet, but may also affect the arms and trunk (such as the feeling of constriction around the abdomen or chest area known as the "MS Hug"). They can be very uncomfortable -- even quite painful -- but are not dangerous or necessarily disabling unless they are severe enough to interfere with a person's activities. Dysesthesias can be treated with medication such as those used to treat TGN but can also be treated with an antidepressant such as amitriptyline (Elavil®), which modifies how the central nervous system reacts to pain.
Pain related to Spasticity
Pain of spasticity has its own subcategories. Muscle spasms or cramps, called flexor spasms, may occur. Treatments include:
- Medication with baclofen (Lioresal®) or tizanidine (Zanaflex®), benzodiazepines, OTC magnesium, ibuprofen, or other prescription strength anti-inflammatory agents, among others.
- Regular stretching exercises and balancing water intake with adequate sodium and potassium, as shortages in either of these can cause muscle cramps. THIS is very important.
Tightness and aching in joints is another manifestation of spasticity, and generally responds well to the treatments described above.
UPMC pain management Pain Medicine Program at UPMC | Pittsburgh, PA