Pain: A Common and Complex Symptom
Pain is a common and complex symptom for people living with multiple sclerosis. Creating and maintaining strategies for managing pain is an important component of wellness.
It is estimated that approximately 65% of the MS population experiences some form of pain, which is an internal experience that others cannot see. Pain is a complicated symptom to address because it has many causes and many treatment approaches. For these reasons, it is important for people to develop a useful and common vocabulary when discussing pain with their health care team and planning their best course of treatment. Often times, the focus of treatment is managing rather than eliminating pain. However, pain left unmanaged is often associated with poor quality of life with respect to emotional well-being, personal relationships, concentration, and physical functioning.
When pain is caused directly by MS because of a demyelinating lesion, it is called MS central neuropathic pain. It may be continuous and produce dysesthesias or abnormal sensations of the skin that are described as tingling, burning, aching, or band-like and can occur spontaneously or by touch.
Episodic central neuropathic pain is sudden, violent, and can be described as shooting, stabbing, or crushing, and is caused by a “short circuiting” of the nerves that carry sensation. There are 3 common episodic central neuropathic pain syndromes; Trigeminal Neuralgia, Lhermitte’s Sign and Painful Tonic Spasms. The treatment of these types of pain typically involves taking one of several classes of medications. It may take several trials to determine the most useful one. Trigeminal Neuralgia, the most painful and complicated of these conditions, may require surgical intervention.
MS non-neuropathic pain is typically associated with the complications of MS disability. Musculoskeletal pain, including neck, back and joint pain, is often secondary to deconditioning, abnormal walking patterns, incorrect use of mobility aides, and stress on bones. When this type of pain is acute, it a “protective” physiologic signal from your body that it is being injured. If left untreated the condition that produced acute pain may convert to chronic pain even after the injury is healed. This can result in tense muscles and limited mobility. Two types of pain that result from a mix of neuropathic and non-neuropathic pain are muscle spasms and headaches.
Because chronic pain impacts so many areas of a person’s life with unknown causes and still undiscovered cures, the most effective approach to pain management is known as the bio-psychosocial model. This is a comprehensive approach to treatment that incorporates the unique physical, social, and psychological/emotional characteristics of the person being treated. Management approaches typically begin with a thorough evaluation by a pain management specialist. That is followed by a combination of self-management techniques including mindfulness, mediation, and talk therapy that are typically learned with a mental health professional. Stretching and other exercises provided by a physical therapist or occupational therapist, medication management using several different classes of drugs, including marijuana where it is legal, as well as minimally invasive procedures in targeted areas of the body are also important aspects of the bio-psychosocial model.
The most effective plan for any individual to manage the complex pains associated with MS requires attention to physical, emotional and social well-being by the patient and their team of health care professionals. It is very important for individuals living with MS pain to address it as soon as possible so that the best and most holistic management plan can be implemented.
Click here to get even more great tips on this topic by watching our archived webinar on Managing Invisible Symptoms in MS: Pain Management.