Doctor Visit

Managing pain in MS often requires a multi-step approach, involving different types of interventions by a multi-disciplinary team. In other words, it may require time, some patience on your part, and a willingness to advocate for yourself by clearly describing the pain(s) you are experiencing, the timing and intensity of that pain, and any triggers that seem to make your pain worse. 

Tracking your pain

• Keep a pain diary for a week or two, noting the type of pain you experience and when it occurs, so that you can give your healthcare provider(s) clear information.

Describing your pain to your healthcare provider(s)

  • What does your pain feel like?
    • Aching, stabbing, throbbing, burning, crushing, electric-shock-like, or something else?
  • When does your pain occur?
    • Does it come and go or is it constant?
  • Does your pain seem to have any triggers?
    • Physical activity, heat or cold, bending your head forward, chewing or talking, feeling anxious or depressed, pressure from bedsheets or clothing, or something else?
  • How intense is your pain?

Managing your pain, including the use of non-pharmacologic and pharmacologic approaches

  • Non-pharmacologic interventions include:
    • Psychological interventions such as cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness, and relaxation training; 
  • Pharmacologic approaches differ according to the type of pain.
    • Botulinum neurotoxin can be helpful for managing spasticity or painful muscle spasms.
    • Some antidepressant and anti-seizure medications have been shown to be effective for neuropathic (nerve) pain.
    • A consultation with a neuropsychiatrist – a psychiatrist who specializes in neurologic disorders like MS – can help determine if and which medications are appropriate, given a patient’s individual medical history and other factors such as current medications and mental health history.
  • Cannabis for pain in MS is a strategy that has recently been the focus of extensive research. A recent systematic review suggested that cannabis, when compared to a placebo, showed some benefits for improving spasticity; however, more studies are warranted to determine which types and dosages of cannabis are most effective.4,10 Long-term side effects of cannabis use in adults with MS (e.g., cognitive effects) remain under investigation.

Given that any single therapy by itself is not usually sufficient for managing MS pain, a referral to a comprehensive, multi-disciplinary pain management program or a physical medicine and rehabilitation program is recommended. These programs offer many of the approaches described above, and work with each individual to determine the optimal combination of therapies and strategies.