Pain in multiple sclerosis part 3 – Secondary pain

Pain is defined as an “unpleasant sensory experience associated with actual or potential tissue damage or described in terms of such damage”. But data available in research literature on pain management is sadly lacking so symptom management in MS represents a primary focus for health care professionals.

A lot of the pain in MS is due to immobility or poor posture, rather than directly related to damage to the nervous system. In particular, using the same posture repeatedly with mobility aids (e.g. a frame or wheelchair) will put stress on your body, which can cause pain. A physiotherapist can provide useful guidance in this area.

Non-medical approaches to pain management include massage, hydrotherapy, acupuncture and reflexology. However, these activities should be discussed with your doctor beforehand.

Then there are::-

• relaxation techniques,
• meditation,
• prayer,
• breathing techniques,
• self hypnosis
• and psychological interventions such as psychotherapy.

The most important thing is to get pain treated. You should discuss where and how much pain you have with your healthcare provider. Your own description of the pain is the most important aspect of pain assessment.

Unfortunately, knowing how something feels does not mean it is easy to describe. Health professionals often talk about pain being ‘acute’ (short-term) or ‘chronic’ (long-term). But describing how it affects you will be an individual thing. When you do describe it, use whatever words seem to best sum up what you experience, however odd they may seem at first. Here are just some of the words people use to describe pain:

• squeezing or crushing

• cold

• hot or burning

• sharp

• dull

• like ants under my skin or ‘creepy crawlies’

• like a build up of pressure

• stabbing

• creeping

• like an electric shock

Being able to explain your pain also helps family, friends and carers understand this ‘invisible symptom.’

So let’s look at some of the types of secondary pain in MS

Musculoskeletal Pain

Description

Stiff joints and muscle contractures, caused by the physical stress of immobility. It can affect the neck, the back or limb joints.

Non medical treatments

Stretching exercises, posture & gait examination, orthotics, exercise

(Especially swimming), position changes, support and cushioning, application of heat and cold.

Usual medications

Ibuprofen, diclofenac  and naproxen.

Nerve Pressure Pain

Description

Pain caused by pressure on the nerves from immobility or poor posture.

This can include sciatic nerve pain from pressure on the back of the leg and ulnar nerve pain from pressure on the elbow.

Usual treatment

Correct seating is important, but elevation of the legs will usually relieve pressure pain.

Back Pain

Description

This can be caused by muscle weakness, abnormal posture, spasticity and spasm. It may also occur as a result of osteoporosis or MS lesions in the spinal cord. If the osteoporosis was steroid induced changing treatment options often eliminates the pain

Usual treatment

Evaluation to pinpoint the source of the pain is essential, as treatments differ widely. It is also important to note that back pain is not always related to MS even though we all think that all of our symptoms must stem from it.

Pain from MS symptoms and treatments

Description

It is worth remembering that certain drug treatments can have painful side effects. Some people taking beta interferon, for example, experience headaches and flu-like symptoms such as aching muscles, particularly in the first few months of taking the drug. Ibuprofen and paracetamol can both help control these side effects.

Some people taking Copaxone (glatiramer acetate) notice an uncomfortable feeling of tightness or pain around the chest.

Some MS symptoms can cause pain as well as the symptom itself, such as pressure sores, urinary retention and infections. A particular example is pain due to Optic Neuritis—an MS symptom that occurs when the optic nerve is stretched or inflamed (with pain occurring behind the eyes which is intensified with eye movement). Painful optic neuritis is probably a unique kind of pain. In addition to pain, optic neuritis can be accompanied by blurred vision, visual acuity loss, impaired colour vision and complete or partial loss of vision. This was one of my first symptoms although I have fortunately never lost total sight. The painful eye movement did however make it almost impossible to reverse the car wherein I had to look over my shoulder. I also did not seek help tp have this treated but Corticosteroids (oral prednisone and intravenous methylprednisolone) can significantly increase the rate of recovery from optic neuritis.

It is also treated with painkillers like ibuprofen, diclofenac or naproxen.

People with MS can also experience pain as a result of treatment

for the condition. Two examples include injection-site reactions and steroid-induced osteoporosis.

Usual treatment

It is very important to discuss each particular problem with your healthcare provider. Fortunately, fixing the initial problem or changing treatment options often eliminates the pain.

For injections site reactions there are a number of things you can do.

If you get lumps post-injection then try a warming (not hot) pad pre-injection to loosen the sub-coetaneous fat. If the lumps persist then gently massage the area but if the lump develops a discharge contact your doctor as it is possible it has become infected.

If you experience itching or stinging then try using an ice pack for a short period of time before and after the injection. If this does not work, discuss it with your doctor as you may need an antihistamine.

For simple redness and inflammation that lasts more than 24hours you could try using a a cream or gel such as Aloe Vera, Witch Hazel or Arnica but do noit try any other opver the counter cream without discussing with your doctor.

Always let the medication warm up to room temperature before injecting and if you’re using an Autoject the setting should be adjusted based on the depth of subcutaneous tissue in the area you plan to use.

Generally these reactions diminish as you become accustomed to injecting and remember to do it at the prescribed interval without missing a dose.

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