Managing MS Symptoms

can occur suddenly and intermittently, or can also be an ongoing chronic pain. Muscle weakness, spasticity and balance problems can cause an uneven gait, contributing in turn, to added wear and tear on back and joints as the body tries to compensate for the weakness. Weak trunk muscles resulting in poor seating alignment can also cause back pain.

Chronic back pain in MS may also result from demyelinating lesions in the spinal cord, or from osteoporosis. As with any pain, an onset of back pain needs to be investigated to rule out non MS causes such as degenerative disc disease, or herniated disc. The first line of treatment is the realignment of the gait patterns, and mobility aids such as a cane may be considered. Treatments need to be directed at the underlying cause if a long lasting improvement is to be achieved.

is one of the most common pain presentations in MS, occurring in people with relatively little disability. It typically is experienced as a persistent burning pain, affecting legs, feet, arms, and the trunk, or any combination of these. It is also described as prickling, tingling, tight, dull, and can even create the sensation of tight banding around the torso. The intensity is generally moderate, and is described as nagging. It is often worse at night or after exercise, and may be very temperature sensitive. As with any chronic pain, it is exhausting and may interfere with normal sleep. First line therapy with a tricyclic antedepressant may be useful as well as gabapentin in sufficient doses. The anticonvulsants carbemazepine and phenytoin may also help. Achieving relief may take a bit of trial and error but in most cases, it can be achieved.

is facial pain occurring on one or both saides of the face. It is severe, sharp, searing; lasting seconds or minutes. It may include facial trigger points. As a presenting symptom in a young person (under 45), is highly suggestive of a diagnosis of MS. It is the result of demyelination of the trigeminal pathway within the brainstem. It can be brought on or worsened by touching, chewing, smiling, or any facial movement. It may be accompanied by numbness around the face. Trigeminal pain also can occur around or behind the eye, and may be confused with optic neuritis. Trigeminal neuralgia affects 2% of people with MS and is 400 times more common in people with MS than in the general population. Management strategies include the use of anticonvulsant therapy.

arbemazepine, is the most effecive, but phenytoin, gabapentin and valproate may be helpful. The episodic nature of this pain makes analgesics less effective than the anticonvulsant class of drugs. Attention to nutrition is important as the pain can make it very difficult to eat adequately.

is a burning, dull, aching or nagging pain. It is also resistant to analgesics and carbemazepine is usually the drug of choice. Special attention must be paid to the nutritional status of these patients as it is quickly compromised by their inability to tolerate chewing.

can be burning, aching, or itching, a sensation of tight banding, and can last seconds to several minutes. It can affect any part of the body including the groin, but usually involves the extremities. It is episodic in nature, and is not related to the degree of disability present. It responds best to amitriptyline, clonazepam, diazepam, gabapentin. The sedating side effects of some of these medications should be considered in patients with marked MS fatigue. Sometimes applications of heat and cold can provide relief.

presenting as flexor and extensor cramping or pulling with pain characterizes painful leg spasms. They are generally associated with more marked disability and weak flaccid muscles. Spasms are often aggravated by irritations like broken skin ulcer, urinary tract infection, full bladder, and constipation, or even by touch. Pharmacological treatment is as per spasticity. In extreme cases, botulinum toxin injections may be tried, but the doses required for large muscle groups may exceed what is safe. Intrathecal baclofen , delivered into the spinal canal via a pump can achieve good results, with low dose consistent medication delivery, minimizing the sedating and other side effects of this drug. The intrathecal pump method is costly and provinces and plans vary with respect to their coverage for it.

Careful attention to hygiene and skin care is especially important as these areas may be compromised by the spasms and are a definite trigger, perpetuating the problem.

are seen in about 17% of people with MS during the course of the disease. Unlike typical seizures, tonic events display no changes on EEG and no loss of consciousness. They consist of brief, unilateral muscle twitching, cramping and spasms of the limbs, preceded and accompanied by intense radiating pain, burning or tingling. These spasms can be provoked by a touch or movement, or may occur quite spontaneously. Carbemazepine is usually effective in controlling these episodes.

The association between headache and MS is unclear, but has been reported to occur in association with exacerbations. Headache may also be related to optic neuritis, tension, muscle spasm at the back of the neck, or even to fatigue and depression. Treatment of the headache is determined by the nature of its origin.