Pain in multiple sclerosis is not uncommon. Around 85% of multiple sclerosis patients report regular pain. This pain can lead to physical or psychological stress. As a patient, however, stress should be kept low, as too much stress can trigger a surge. It is therefore all the more important to treat pain early and adequately.

‍

pain, a physiological warm-up

Why do you feel pain? Pain occurs when tissue is overstrained or injured. It is therefore a physiological warning function of the body. This warning function is intended to prevent pain-causing events or to avoid these pain stimuli. For example, if you place your hand on a hot stove, you feel a strong burning sensation, which causes you to intuitively pull your hand away again. This is an example of how pain can arise.

Pain can be caused by various stimuli on the pain receptors. On the one hand, as in our combustion example, through thermal stimuli such as heat and cold. On the other hand, through mechanical stimuli such as pressure, injuries, contusions or burns, or even through chemical stimuli such as inflammation, acids or toxins. In addition to the various types of pain, there are different types of pain:

Basically, pain can be divided into physiological & neuropathic pain. Physiological (nociceptive) pain is caused by irritation of nerve endings, such as skin injuries, bone fractures or even heat. Neuropathic pain, on the other hand, is caused by injuries or malfunctions of the nervous system. This could be trigeminal pain or phantom pain, for example.

Pain can also be divided into several categories. These categories include duration (acute vs. chronic), pain quality (acute, dull, pulsating, burning), localization (headache, groin pain, joint pain, muscle pain) and the affected organ systems (muscle and skeletal pain, intestinal pain).

Types of pain in multiple sclerosis

Neuropathic pain in particular plays a major role in multiple sclerosis. Neuropathic pain is pain that results from damage or malfunction of the nervous system. Multiple sclerosis disrupts the transmission of nerve signals and can therefore also cause pain. A distinction is made between three types of neuropathic pain: trigeminal neuralgia, dysesthetic pain and the Lhermitte sign.

trigeminal neuralgia

The trigeminal nerve is the fifth of twelve major brain nerves and sensitively supplies large areas of the head that are responsible for feeling. Damage to this nerve leads to neuropathic pain. Even the smallest facial sensations, such as those caused by a draft of breath or when chewing food, can lead to severe, sudden attacks of pain. Only one half of the face is often affected and those affected feel this pain on their upper and lower jaws, lips or cheeks.

dysesthetic pain

Dysesthetic pain is described as constant, burning pain that occurs without external stimuli. Dysaesthetic pain usually occurs in the legs and feet at night, and exercise can increase this pain.

Lhermitte sign

This type of pain occurs when the head is bent forward slightly or strongly. Those affected experience electrifying abnormalities from the neck to the extremities. This pain is caused by stretching the pain-sensitive meninges due to the flexion of the spine.

Other types of pain

In addition to neuropathic pain, multiple sclerosis can also cause nociceptive pain, i.e. physiological pain. MS patients are particularly affected by headaches, muscular pain (e.g. back, neck, extremities) or even pain caused by spasticity and cramps.

‍

Pain management for multiple sclerosis

‍

In order to counteract the chronization of pain, it is recommended to treat it. As a basis for therapy, it can be helpful for your practitioner if you can describe pain symptoms precisely.

‍

Medicinal pain management

Different forms of pain require different pain medications. The first choice for neuropathic pain are anti-cramps, so-called anti-convulsants such as gabapentin or pregabalin. Nociceptive pain is treated according to the WHO step-by-step scheme. This step-by-step scheme was developed by the World Health Organization (WHO) for drug pain management.

A patient is usually treated first as shown in stage 1. Stage 1 consists of non-opioid therapy. If this pain management is not successful, opioids can be used from the second stage.

Non-opioids include drugs such as ibuprofen, paracetamol, or diclofenac. Tramadol or tilidine are low-potent opioids, whereas morphine, oxycodone or fentanyl are highly potent, i.e. very strong opioids. Co-analgesics include antidepressants or anticonvulsants. Aduvants are medications that are used to treat nausea or constipation.

‍

Alternative pain management

However, pain cannot be treated only with medication. There are numerous non-drug approaches, such as physiotherapy, occupational therapy, massages or even heat treatments, which can provide relief. Maintaining mental health is also important and can also help with physical pain. Meditation, mindfulness exercises or even psychotherapy are used here, for example. Traditional Chinese medicine (TCM) also uses acupuncture to treat pain. Not to forget regular physical activity and regular fitness or endurance sports not only for physical health, but also for mental health.

‍

Pain is a common companion of multiple sclerosis. In order to understand the onset of pain, pain should be documented. This pain diary not only helps those affected, but also supports therapists in defining the most appropriate treatment possible. If you suffer from pain, talk to your doctor about which therapy is appropriate and how you can best address your pain.