Sensory Symptoms and Pain
Sensory symptoms can be annoying (and they're also very common) but the good news is that they're often not serious. They may not be indicative of disease progression, and, generally, they are not incapacitating. There is a wide range of sensory symptoms including a pins-and-needles feeling in the arms or legs (and other places), burning or itching skin, changes in how you interpret hot and cold, and others. Unless these symptoms are significantly interfering with your life, your doctor will probably elect not to treat them, although a short course of corticosteroids can be used in cases where the symptoms recently began and are particularly troublesome.
Pain and MS
Twenty years ago doctors believed that pain was not an issue in MS. These days, there is no question that people with MS can experience pain. Recent studies show that neuropathic pain (pain caused by problems in the nervous system) occurs in about 50 percent of people with MS sometime during the course of the disease.
Of course, no two people experience pain in the same way. For some, pain may be fleeting and short-lived, whereas for others, it can be a daily nuisance. Even mild changes in sensations can have an impact on daily life, so it is important that pain is acknowledged and managed. Pain, by the way, is defined as anything that causes you mental or physical discomfort. For some, pain can be exhausting, but it also causes fear, distress, and frustration. This is one of the symptoms you'll want to get a handle on right away.
Pain in MS falls into two categories: primary pain and secondary pain. Primary pain is caused by nerve damage, whereas secondary pain is indirectly caused by MS symptoms.
Primary pain is also called neuropathic pain and is caused by damage to the nerves. There are several types of primary pain:
Trigeminal neuralgia is an intense, sharp, stabbing facial pain and is usually short-lived. It is relatively rare in MS.
Lhermitte's sign is a sudden sensation like an electric shock that spreads to the arms or legs and is triggered when the neck is bent forward.
Dysesthesias are the most common type of pain and include burning sensations in your arms, legs, or trunk, or the “MS hug” — a “girdling,” bandlike feeling around your chest or midsection.
It is important that any pain you are experiencing is correctly diagnosed and properly treated. There are more available drugs and other therapies today for MS pain than ever before and new treatments are in the pipeline.
Only a small number of people with MS will develop trigeminal neuralgia (4 percent). The condition can be very painful and tends to recur. The pain is usually relieved by anticonvulsant or antiseizure medicine, and for those cases that don't seem to be responding to medication, surgery is an option.
Your neurologist may try to treat your neuropathic pain with medication, but you may have to try several drugs to see which one works best for you. The trick is to find relief with the fewest number of medication side effects. There are currently no medications specifically approved for MS pain, but the following drugs have been used with some success:
Cymbalta (duloxetine hydrochloride) was approved by the FDA for the treatment of depression and the treatment of pain associated with diabetic peripheral neuropathy. Although not specifically approved for use in MS, it may be effective for MS neuropathic pain.
Antiseizure medications such as Tegretol (carbamazepine) and Neurontin (gabapentin) are commonly used to treat trigeminal neuralgia and dysesthesias.
Other treatments for primary pain include tricyclic antidepressants such as Elavil (amitriptyline) and antispasticity medications such as Lioresal (baclofen) and Zanaflex (tizanidine), especially if muscle spasms are an issue.
Unconventional treatments such as meditation and acupuncture may also be able to help. Years ago, unconventional therapies (also known as “complementary and alternative medicine,” or CAM) were often seen as being on the fringe, but they have been increasingly recognized over the past several years.
Secondary pain refers to the types of pain that are secondary to the disease process itself, such as muscle stiffness and spasticity. Another common type of secondary pain is musculoskeletal that results from muscle weakness, immobility, and deconditioning. It's important to keep in good physical shape, and this is where a physical therapist, orthopedist, or personal trainer comes in. Talk to your doctor about these types of pain to decide which specialist will benefit you the most. He may also suggest over-the-counter analgesics, such as Motrin (ibuprofen) or Tylenol (acetaminophen).