Multiple sclerosis or MS is a disease that affects the central nervous system.
This is the brain and the spinal cord.
It is an inflammatory disorder in which the immune cells enter the central nervous system
and attack the myelin that covers the neurons.
Early signs of MS include numbness, tingling, difficulty walking, fatigue, visual problems,
urinary incontinence, sensations of electrical shocks through their back and arms, and pain.
In this video I’ll explain what kinds of pain people with MS may have and how to treat
them.
So, let’s talk about MS and Pain
Before I continue, please remember that this video is for educational purposes only.
If you have a medical condition causing chronic pain, talk to your doctor.
If there is an emergency go to the nearest emergency department or call an ambulance.
Fortunately, not everyone with MS will have pain.
But the studies suggest that more than 50% of people with MS will have pain at some point
of the course of their disease.
And there are different types of pain that can affect people with MS, some of them are
related to the damage caused by Ms, but other kinds of pains are the same as everyone else,
even people without MS would have, like mechanical back pain, fibromyalgia or arthritis.
Here is a summary of the types of pain that people with MS have:
In the acute phases of the disease, when the immune cells are causing the disruption in
the myelin, the person may have: Optic neuritis.
This is a kind of pain with movement of the ey
Trigeminal neuralgia is pain in a nerve of the face, the trigeminal nerve.
It is known as Tic Douloureaux.
It is pain when the person opens and closes their mouth, or tap on the side of their face.
Lhermitte’s phenomenon, which are like spontaneous electrical shock sensations in the spine,
arms or legs, and muscle spams.
Painful tonic spasms, this is the typical MS hug that people refer.
The muscles of the trunk will go into spams, it is brief and may occur various times of
the day.
It can also affect the whole leg or the whole arm and it can last many minutes.
And they are precipitated by movement.
If the loss of myelin occurs in sensory pathways, the person may also have tingling, numbness,
pins and needles, stabbing pain and burning pain.
This is called neuropathic pain.
If the loss of myelin occurs in the motor pathways, that control the muscles, then the
person may have paralysis, weakness or increased rigidity of the muscles, we call this spasticity.
When the muscles have spasticity they may hurt and the treatment is to reduce spasticity.
Other types of pains that may affect people with MS are conditions that affect anyone
else.
However, it seems that people with MS have a higher incidence of these other painful
conditions than a person without MS.
These conditions are: Headaches, may be more frequent in people
who have relapsing MS Migraines
Back pain.
It is usually due to lack of physical activity, weight gain, scoliosis or wheelchair use.
Fibromyalgia.
Myofascial Pain syndrome Stress-related pain or emotional-induced pain.
Of course, the person with MS will have a lot of stress
We treat pain in MS the same way that we treat any other type of chronic pain.
The first step is to diagnose what kind of pain the person has.
Is it nociceptive, neuropathic or nociplastic?
I have another video that I explain the difference between these 3 types of pains.
To summarize here, nociceptive pain is pain that occurs when the pain system is functioning
well and it is there to detect that there is an intruder or injury to our bodies.
This could be a fracture, a burn, a cut, or an acute inflammation like appendicitis or
tonsilitis.
This would be similar to an alarm of a house where there is a fire and the alarm goes off
to alert that there is a need to call the firetruck.
Neuropathic pain is pain that occurs when the pain system is affected, it is like when
the alarm system of the house is malfunctioning.
Like there is a malfunctioning wire, or a sensor that is broken, then we need to fix
the alarm system, or the pain system.
This is exactly the case of MS.
MS is a condition that affects the nervous system.
The third type of pain is nociplastic pain.
This is the typical mechanisms for chronic pain.
After the nociceptive or neuropathic pain have been resolved, the injury has been healed,
or the myelin has been repaired, the pain system had been sensitized, and now there
is no more injury or lesion, but there is a memory of the pain in the brain, and the
person keeps feeling pain even after many years that the original injury has healed.
So, we need to retrain the pain system to get rid of those past memories of pain.
An example of nociplastic pain is fibromyalgia.
Of course, there are people who have a mix of all these 3 types of pains.
We need to remember the toolbox of 5M to treat pain: Mind, Movement, Modalities, Manual and
Medications.
So, let’s talk about how we treat each kind of pain with these 5 M tools in our toolbox.
Nociceptive pain.
People with MS may have pain from inflammation, arthritis, myofascial trigger points, or tendinitis.
The treatment for nociceptive involves Mind-body therapies to relieve muscle tension
and anxiety.
Movement: For arthritis remember the LAWS exercises: lubrication, aerobics weight-bearing
and stretch/strengthening.
For myofascial pain remember the SSAR exercises: Stretching, strenghthening, aerobics and relaxation.
Modalities: you may use heat or cold for arthritis.
TENS for tendinitis and muscle pain.
Acupuncture and Taping.
Manual therapies: you may try massage, manipulations and mobilizations.
Those are specially useful for neck and lower back pain.
Medications: if necessary, you may use acetaminophen or anti-inflammatories.
You probably don’t need opioids for nociceptive pain.
People with MS may have neuropathic pain, and that is very common because MS is a disease
of the nervous system and affects the brain and spinal cord.
For neuropathic pain, the main treatment involves: Mind-body therapies.
Using techniques that relax our body and mind will help the person not to panic and be fearful
of the pain.
Medications.
The types of medications are antidepressants, anticonvulsants, opioids, lidocaine, ketamine
and cannabinoids.
I have another video in that I talk about the antidepressant amitriptyline, duloxetine,
and I also have other videos about the anticonvulsants gabapentin and pregabalin.
These medications are helpful because they act in the neurotransmitters inside the central
nerve system.
They do have side effects and the most common is sedation, which may be a problem for people
with MS who are already affected by fatigue.
There is some evidence that medications containing THC are effective to reduce neuropathic pain
in MS.
Watch my other video about cannabinoids for pain.
I don’t recommend the person to smoke cannabis as this would bring too many toxins to their
lungs and could cause more harm.
If they want to try cannabis, I recommend oral medications containing a mix of THC and
CBD.
People with MS may have nociplastic pain.
This is because the pain system has been sensitized by the other types of pains and is now malfunctioning.
For nociplastic pain we need to introduce the following treatments:
Mind-body therapies.
Pain is not just a sensation of the body.
Pain is a sensation that is interpreted by our emotions and thinking.
If our thinking is pessimistic, then we tend to feel more pain than when our thinking is
more optimistic.
So, talking to a counsellor, mental health specialist, psychologist or psychiatrist can
help the person to analyze how they are interpreting their pain.
Many times we tend to make it worse than it is.
And it is very helpful to learn techniques how to think differently about pain.
Some of these strategies involve meditation, mindfulness, relaxation, distraction, biofeedback,
cognitive behavioural therapies, acceptance and commitment therapy or brain retraining
techniques.
Watch my other video that explain various types of mind-body therapies.
Movement is very important to retrain the pain system.
I usually recommend aquatherapy or hydrogynastics.
Modalities are not very helpful to treat nociplastic pain
Manual therapies are also not indicated to treat nociplastic pain
Medications, we don’t have medications to retrain the pain system.
In some cases we use antidepressants and anticonvulsants because they increase the neurotransmitters
that are affected in people with chronic nociplasitc pain, but medications is not the first choice.
If the person is using opioids we tend to reduce the dose and stop opioids because opioids
can aggravate pain and lead to opioid -induced hyperalgesia.
Watch my other video that I explain wht is OIH, or opioid-induced hyperalgesia.
Last, for all types of pain in people with MS, there are other measures that help them
to regain quality of life.
These include: Nutritional support.
Diet is very important to people who have MS.
I recommend them to talk to a dietitian or nutritionist to get all vitamins, elements
and nutrients that they need.
Maintain a healthy weight.
Avoid underweight or overweight.
Exposure to sunlight is good to keep a good production of Vitamin D, but also sun exposure
during the day helps the person to sleep better at night.
And going outdoors, keeping in touch with nature and fresh air is an excellent type
of mindful therapy.
I have a video that I show the benefits of walking outdoors.
Sleep hygiene.
A person with MS will feel fatigue during the day and insomnia during the night.
It is really important that they avoid caffeine before bedtime, the room is dark, cold temperature
and with low noise.
It is recommended to keep a routine of what time they go to bed and what time they get
up from bed.
I have another video that I give many tips to improve sleep efficiency.
Quit smoking, this includes tobacco and cannabis.
Practice meditation regularly.
This is important not only for pain, but for their general quality of life.
Because MS can be a stressful diagnosis, the person may feel overwhelmed with a lot of
information and new routines.
It is important to take time to look inwardly and pay attention to the things that are important.
Keep working, studying and socializing.
Continue attending religious activities, volunteering and helping other people.
This will help them to keep focused on their life goals, their dreams, their role as a
person in their families, society and to fulfill their purpose in life.
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I post videos about diagnosis, treatment and prevention of chronic pain.
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Bye