Pain in multiple sclerosis part 2 – Neurogenic pain

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Half of all people with MS will experience pain from time to time because of the condition. Fortunately for most, the pain is usually mild. But, for a small number, pain is a more severe and ongoing symptom that may need specialised assessment and treatment. In this article I will address pain which arises from damage to the nervous system.

Interestingly the most common areas for this type of pain are the face, neck

and torso so let’s start at the top with TGN

Trigeminal Neuralgia

TGN is an excruciating, sharp, shock-like pain in one side of the face, lasting seconds to minutes and often repeated; may be triggered by speaking or a touch. It usually settles spontaneously by itself over several weeks. Unfortunately many of the side effects of the usual drugs mimic the symptoms experienced in MS anyway so it is difficult to tell the cause and it may lead to alarm that the disease is getting worse. To allay these fears I have outlined the usual side effects of each drug,

Usual medications

Carbamazepine (anticonvulsant): Side effects Drowsiness, Dizziness, Coordination difficulties

Phenytoin (anticonvulsant): Side effects Dizziness, Nausea, Insomnia, Uncontrollable eye movements, Coordination difficulties, Slurred speech, Confusion

Baclofen (muscle relaxant): Side effects Weakness, Drowsiness, Dizziness

Gabapentin (anticonvulsant) may also help: Side effects Dizziness, Coordination difficulties, Fatigue

Lhermite’s Sign/Symptom

This is a  brief, stabbing, shock-like sensation that runs from the back of the head down the spine, (like an electric shock) brought on by bending the neck forward. It is not always painful.

Usual medications

Carbamazepine or Phenytoin (see above)

Other treatments

A soft collar may limit neck movement. Most often Lhermite’s symptom disappears spontaneously and medical treatment is not necessary.

Tonic Spasms

These, known as spasticity are sudden and painful muscle contractions, producing stiffness of the whole limb, which can last up to two minutes.

Usual medications

Carbamazepine, phenytoin, and baclofen (see above) and

Clonazepam (anticonvulsant): side effects Sedation, Dizziness

Dysaesthetic Pain in Limbs and Trunk

Dysaesthetic means any impairment of the senses especially the sense of touch

This is a condition in which light physical contact of the skin causes pain; Such as the weight of sheets in bed.  It involves a persistent burning, tingling, tightness, or aching which may be worse at night and after exercise It may be aggravated by temperature and weather.

Patients frequently state that dysaesthetic burning corresponds with what they imagine a hell might be like. Some of the descriptions given by patients include:

- “Like Hell’s hottest knives tearing at my flesh”
- “Like my flesh is being consumed in a fire”
- “Like my flesh is being torn from my body”
- “Like my flesh has been burned off”
- “A pain worse than pain”
- “Indescribable burning”
- “Like an alien pain monster has taken over my body and has ignited my flesh”

Usual medications

Nortriptyline and amitriptyline.(anti-depressants): side effects Dry mouth, Blurred vision, Sedation, Urinary retention

Gabapentin, (see above)

Tegretol (Carbamazepine – see above) and Epilim (sodium valproate – anti epileptic) may also be useful.

Side effects of Epilim nausea, diarrhoea, increased appetite and weight gain, shaky movements, tremor, drowsiness, confusion, temporary hair loss

Other treatments

• Application of cold, pressure stockings
• Capsaicin ointment/cream. Capsaicin is the active ingredient in chilli peppers. It’s what gives chilli peppers their kick. When it is applied to the skin, capsaicin cream has been found to deplete substance P— a neurochemical that transmits pain—which desensitizes a person to pain. Capsaicin cream produces a temporary reduction in pain, so it must be used regularly to provide prolonged pain relief.

Capsaicin can cause an intense burning feeling when it is applied, particularly if it is used less than 3-4 times a day, or if it is applied just after taking a hot bath or shower. However, this side-effect tends to ease off with regular use. Capsaicin cream should not be applied to broken or inflamed skin. Wash your hands immediately after applying capsaicin cream.

In my next article I will be discussing secondary pain in MS.

Tags:course of MS,living with ms,ms symptoms,ms treatment,multiple sclerosis treatment,quality of life,symptoms

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