Musculoskeletal Or Secondary Pain
Also called nociceptive pain, this is usually a result of the symptoms of MS, such as spasticity, weakness, immobility or problems walking, and not the disease process itself. Some examples of this are:
- Joint pain: Many people with MS feel pain in the joints of the hips and knees due to imbalance and a change in gait.
- Stiffness: A person with MS may experience stiffness in the legs, arms, and hips due to immobility.
- Back pain: Back pain can be the result of an unsteady gait, immobility, trying to adapt to the annoying feeling of the MS hug, sitting for extended periods in wheelchairs or any constant adjustment in movement or position as a result of MS symptoms.
- Pain from spasms: Flexor spasms cause a limb to contract, or bend, towards the body. This can make the limb feel like it has a constant cramp or dull ache.
Examples Of Musculoskeletal Pain Are:
- Hip and back pain caused by alterations in how you walk due to MS, possibly because of muscle stiffness , weakness or problems with balance.
- Back pain due to sitting for long periods because of fatigue, walking difficulties or inability to stand for long.
- Muscle or joint pain due to changes in posture, spasms or muscle stiffness
Can Ms Relapses Be Prevented
MS flares may not be completely preventable, but the newer disease-modifying medications for MS have been shown to greatly reduce relapses. However, it can take a few tries to find the drug that works best for the individual.
Aside from medication, remaining calm and adopting a positive attitude whenever possible can help prevent a flare from coming on, says Chester. Keeping your stress level at a minimum and taking care of yourself really does help, she says.
Listen to your body and reach out for support from friends and family. If you need something, ask, says Chester.
Here are some common MS symptoms and a few self-care tips to manage them:
Have a plan to head off fatigue. MS fatigue is not like normal fatigue. It can be so severe that it’s disabling. But having good sleep habits, avoiding caffeine and too much alcohol, and getting some daily exercise are good ways to prevent MS fatigue, says Dr. McCoyd. There are also medicines that help fight MS fatigue.
Find workarounds for brain fog. Slowed thinking, confusion, and difficulty concentrating are frequent but under-recognized MS symptoms. It can be infuriating for me, because Im a writer, says Chester. I have issues finding the right word that I want to use, or I cant remember facts that I know by heart, she says. Two strategies that can help you stay focused and remember things better are to avoid multitasking and to write things down. Cognitive rehabilitation can also help.
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Does Ms Cause Neuropathic Pain
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Does ms cause neuropathy?
Both MS and peripheral neuropathy can cause tingling, pain, or decreased sensation of the hands, arms, feet, or legs. The tingling and other sensory problems of MS tend to affect one side of the body, while they generally affect both sides in peripheral neuropathy in what is described as a stocking-glove pattern.
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People Explain What It’s Really Like To Live With Ms
After Jamie-Lynn Sigler’s announcement, we asked several individuals who have multiple sclerosis to share their experience with the disease. These are their stories.
Editor’s Note : Jamie-Lynn Sigler appeared on the Today show this morning and spoke about the great sense of relief she has experienced after revealing that she has MS.
Jamie-Lynn Sigler is finally opening up about a private battle she’s been facing for the past 15 years living with multiple sclerosis.
In a new interview with People, the Sopranos actress explained that she wasn’t ready to speak out about her condition until now: “You’d think after all these years somebody would be settled with something like this, but it’s still hard to accept.”
Multiple sclerosis is a disease in which the body’s immune system attacks myelin, the protective sheath around nerve cells that helps send messages to the brain and other parts of the body. Common signs of the disease include trouble walking and maintaining balance, fatigue, sensations of numbness or tingling, and vision problems. But depending on which nerves are affected and the level of damage, symptoms can vary widely from person to person, and may not surface right away or progress steadily.
Because no two cases are alike, and MS can be so tricky to understand, we reached out to several individuals who are living with the disease, and asked them what they wished other people knew about it. Here are their stories.
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How Are Ms And Foot Pain Related
A common complication of MS with regards to feet is a condition that doctors refer to as erythromelalgia. It is a disorder that affects the feet and is characterized by intermittent episodes of intense burning pain in the extremities.
The skin becomes extremely red with an unusually high temperature and is usually accompanied by swelling. Affected individuals also report experiencing tingling pain and other symptoms commonly associated with peripheral neuropathy .
In other cases, some people with MS experience musculoskeletal pain in the joints of the hips, knees, legs, and feet, mainly due to extended periods of immobility and spasmodic pain in the flexors. These make the foot feel like it has a constant dull ache or cramp.
It Was A Really Rough At First Both Emotionally And Physically But Therapy Helped
I was able to find a neurologist who gave me corticosteroid treatments, which helped. But in addition to my original symptoms, I developed a bad case of optic neuritis, which causes vision problems. I couldnt really see anything, even with my glasses, so I thought I was going blind as well. But I got better after the steroid.
But when you take a steroid, you dont feel great I couldnt sleep, I had heart palpitations, and my face and chest broke out with the worst acne you have ever seen.
I was so anxious about my future. I thought, Who is going to marry me if I have this disease? Am I going to be unlovable? My husband and I were dating when I was first diagnosed and I was so scared he would not want to be with me anymore. That wasnt true he has always been there for me. But it was so, so stressful at the time.
I was seeing a therapist and she really helped. I know it sounds cliché, but having a positive mindset is so important. And its not like you can just say, Im going to be a positive person today.” You really have to work at it. But I do think that you can change your thought patterns, sort of like retraining your brain.
Marni is the founder of MSquared: Music Against MS, which raises funds for MS research, and we work on charity events together. We have an event on May 16 in New York, which will be hosted by HQs Scott Rogowsky.
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When Are Opioids Prescribed
With certain diseases and conditions involving severe pain that is not responsive to other drugs, opioids are a type of drug that is sometimes prescribed. With MS, opioids are not as effective, and they are typically avoided. When these drugs are prescribed for any condition, doctors are cautious, as people become dependent upon them when used for a period of time. This is not a problem if managed correctly by the prescribing doctor, and when discontinuing the drug, care is taken to do so gradually. However, some people will abuse this type of medication.
What are opioids? Opioids are all related to morphine, and include such familiar brand names as OxyContin® and Percocet® , and Vicodin® . Several other related drugs are members of the opioid family, including morphine, which is marketed under the brand names of Astramorph® and Avinza®. According to WebMD, Opioid analgesics suppress your perception of pain and calm your emotional response to pain by reducing the number of pain signals sent by the nervous system and the brains reaction to those pain signals.
Heidi W. Maloni, PhD notes, Opioids are used in MS pain, but not as a first-line drug. I will often use the weaker opioid-drug tramadol as a rescue drug when the pain of trigeminal neuralgia becomes unbearable, or in cases of burning dysesthesias. I try very hard to avoid opioids.
Time And Timing Differentiate Two Types Of Ms
There are two main types of MS:
- Relapsing-remitting MS is exactly what it sounds like: New neurological symptoms develop caused by inflammatory attacks on myelin, called a relapse, followed by periods of recovery where the symptoms may improve, remain but not worsen, or go away. This period is called remission.
Relapsing-remitting MS is the most common form of the disease. According to the National Multiple Sclerosis Society, approximately 85 percent of people with MS are first diagnosed with relapsing-remitting MS. Most diagnosed with this type of MS are generally in their 20s and 30s.
- Primary-progressive MS occurs when there’s no improvement in symptoms from the onset of disease. “There may be subtle improvements, but overall, the trajectory is continued worsening over a period of at least a year,” Shoemaker explains.
This form of MS can be more difficult to diagnose since people with the primary-progressive type tend to have less brain scarring, more spinal cord scarring and less inflammation than those with relapsing-remitting MS. They also have more difficulty with mobility and everyday activities, and onset usually occurs in the 40s or 50s.
Whereas 80 to 85 percent of cases of MS are relapsing, primary progressive MS is about 15 percent of the cases at diagnosis, and a 50-50 split between men and women.
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Exercise And Physical Therapy For Ms Pain
Neuropathic pain, says Cross, doesnt tend to respond much to exercise or physical therapy. But these approaches can work well in many people with spasticity or musculoskeletal pain.
Usually I try to do those in combination with medical therapy, says Cross.
Both Cross and Freeman stress the importance of stretching for people with spasticity. I find it is essential to encourage people with MS to stretch daily in particular the muscles that are most effected by the cramps, says Freeman.
Freeman also encourages people with spasticity or musculoskeletal pain to exercise for at least two hours each week, from light walking to more active forms of exercise like circuit training, in which you move from station to station to complete a sequence of exercises, with no rest time between the exercises.
Physical therapy can be especially helpful for musculoskeletal pain, says Cross. You can sometimes build up the opposing muscles with certain physical therapy maneuvers, she says, which helps to eliminate the root cause of the pain.
Freeman says that many of her patients benefit from stretching in the context of yoga classes light, restorative yoga, rather than more intense variations of the practice. She recommends looking into offerings at a local gym or YMCA, or seeing if the National Multiple Sclerosis Society offers any classes in your area.
People With Ms May Experience Pain For Other Reasons Including:
- as a side effect of medication eg headaches or injection site reactions to disease modifying treatments
- as a result of infections, such as a bladder infection
- from an accident or other health condition not related to MS
It is common to experience more than one type of pain.
Treating MS pain may include drugs or non-drug treatments, such as physiotherapy. You can also make changes to your everyday life so that pain has less impact. Effective pain management often means trying a range of approaches to see which ones work best for you and then adopting several at once to get the best overall effect.
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Treatments For Musculoskeletal Pain
Musculoskeletal pain may be helped by common pain relieving drugs such as paracetamol, ibuprofen or aspirin. If the pain is due to muscle stiffness , then treatments for spasticity may be offered.
A physiotherapist can identify any changes in your posture or walking that may be causing pain. They can also advise you on exercises to strengthen certain muscle groups and so keep you flexible and mobile and reduce your pain. If you have difficulty moving, a friend, family member or carer may be able to gently help you stretch.
If the pain has arisen as a result of poor posture when sitting or standing, a physiotherapist will help you to correct that posture and relieve the strain on the painful joints or soft tissues. A referral to the wheelchair clinic may also be helpful to be assessed for devices, like shaped cushions or T-rolls, to use in your chair to improve posture.
An occupational therapist can suggest equipment that might help you at home or work, or when getting out and about. OTs may also suggest lifestyle changes to make things easier for you and help relieve your pain. Making several small changes can add up to a large improvement in managing your pain.
You Might Like To Think About Whether The Feeling:
- comes in short or long lasting bursts or is there all the time
- started suddenly or increased bit by bit
- started at the same time as other new symptoms or when previous symptoms came back quite suddenly. This may suggest that your pain is part of a relapse.
- improves with pain killers or is relieved by changes you have made like applying heat or cold, relaxing or sitting in an upright chair
- gets worse when you do certain things.
- has happened before. When? Does it feel the same?
- is stopping you doing what youd like to do. Give some examples such as its affecting your sleep, your work or your ability to sit down for long. It is good to say exactly whats happening, for example, it takes you two hours to get to sleep or you can only sit still for 20 minutes at a time.
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Drug Treatments For Nerve Pain
Not all nerve pain will be treated, for example, numbness and loss of sensation may not be treated unless they are causing particular distress.
The National Institute for Health and Care Excellence has issued guidelines for the treatment of nerve pain. As common painkillers are not effective against nerve pain, NICE recommends that people with MS should try amitriptyline, duloxetine , gabapentin or pregabalin first. Treatment usually starts with a low dose and then builds up slowly until an effective dose is reached. However, as pain is different for each person, health professionals may recommend different options depending on what may be best for you as an individual.
With any treatment, there is the possibility of side effects so these should be discussed. Many side effects wear off or can be managed effectively. For example, if a medication makes you sleepy, it may be best to take it last thing at night. This way it could act as a positive in helping you sleep if your nights rest has been disrupted by pain.
The guidelines also suggest that you and your health professional should agree a treatment plan that takes into account your concerns and expectations. Your treatment should be reviewed regularly and, if a drug is not working well enough, one of the others should be tried.
Although, nerve pain can usually be improved with drug treatments, it is often best to take other steps to managing the pain yourself .
Recovering From An Ms Relapse
Severe MS flares are usually treated with several days of high-dose, intravenous steroids, which can be administered at a medical facility or self-administered at home.
Steroids reduce inflammation and speed recovery from a flare, although they dont correct the damage to the nervous system.
For people who cant tolerate or dont respond to steroids, there are other treatment options.
Some people recover fully from a flare, while in others, symptoms experienced during the flare linger afterward, though they may gradually improve over time.
Various forms of rehabilitation can help restore physical and mental functioning thats been affected by an MS flare.
Additional reporting by Becky Upham.
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I Woke Up One Morning And Couldnt Move My Neck
It was the summer of 2011 and and it was really hot in my apartment. I started having pain in my neck and back, but I figured it was because I was sleeping with the air conditioner on full blast, which was making my muscles tight. But it kept going on and on, and after a few weeks I woke up and couldnt move my neck at all. I was in so much pain. It was about a week before my birthday, and I was about to turn 27.
I thought I had a pinched nerve. I called the doctor and they were able to get me in that day. The doctor agreed that I probably had a pinched nerve, but sent me for an MRI just to be sure.
The next day my doctor called and asked me where I was, and I remember thinking, Oh my gosh, I am dying. I was so scared. They could see lesions, these dots, but werent sure what they were because the MRI had been done without contrast dye. The doctor thought it was either MS or one of two other horrible conditions I dont even remember what they were so I had another MRI, this time with contrast.
This was on a Friday and they sent me for the next MRI on Saturday. I got a call about an hour after the scan, and thought, This is not a good sign that my phone is ringing.
