“Research from Taiwan indicates that capnellene (GB9), a compound extracted from the soft coral Capnella imbricata, could prove useful for treating neuropathy and neuropathic pain.”

When pain is the result of a disruption or alteration of nerve conduction, it is termed neurogenic or neuropathic. Pain caused by nerve damage can range from a mild prickling to severe burning, itching or aching and usually requires different treatment from musculoskeletal pain.

Pain management is approached medically, behaviourally, physically and in some cases, surgically. If it is treated with drugs it is always a balance of risk versus benefit. In other words, medication side effects need to be considered and continually evaluated in terms of their impact on a person’s quality of life.

Neuropathic pain responds variably to currently available drugs; painkillers, antidepressants and anti-epilepsy drugs often have no effect.

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

Zhi-Hong Wen. said “Capnellene could be the first of a new generation of painkillers that are more effective than steroids or opiates and do not have their potential side effects or their addiction-forming properties,”

CB09 and its derivative GB10 have been looked at with two proinflammatory molecules which were reduced to almost control levels at the highest GB9 and GB10 concentrations tested.

“We are currently investigating the effects of GB9 and GB10 in other animal models of osteoarthritic pain, multiple sclerosis and Parkinson disease, as the compounds could also be potent therapeutic agents for a range of neuroinflammatory diseases,” says Wen.

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Pain is generally not associated with MS but findings of worldwide MS research studies suggest that pain is a key factor in MS, indeed approximately two thirds of people with MS experience pain at some time during the course of the disease; pain is undertreated; and that pain is associated with depression, anxiety and fatigue although not the sole cause of these symptoms.

Although MS pain was first recognised in the 1800s, it was not until the 1980s that the incidence, prevalence and characteristics of MS pain were described.

The severity or frequency of pain varies from person to person. It cannot be predicted by a person’s age, gender, or type of MS. However, the longer someone has had MS, the more likely they are to experience pain as one of their symptoms.

The most common pain syndromes experienced with MS include:

● headache (seen more in MS than the general population)
● continuous burning pain in the extremities
● back pain
● painful tonic spasms (a cramping, pulling pain)

Why does pain occur in MS?

Pain is a sensory symptom directly related to two occurrences – the disruption of central nervous system myelin and the effects of disability.

In other words pain may be directly related to the disease itself (e.g. pain associated with nerve damage), or it may develop because of other MS problems (e.g. pain caused by painful muscle contractions and stiffened joints). Fortunately, most pain in MS can be treated.

When pain is the result of a disruption or alteration of nerve conduction, it is termed neurogenic or neuropathic. Pain caused by nerve damage can range from a mild prickling to severe burning, itching or aching and usually requires different treatment from musculoskeletal pain. In some chronic pain conditions, the constant barrage of pain signals may overwhelm the central nervous system so much that normal sensations such as the stroke of a hand can trigger pain.

Neurogenic pain

Neurogenic pain is described in varying degrees of severity and can be split into two types:
•    Continuous and steady
•    Spontaneous and intermittent,

One large North American study found that half of those reporting pain said their pain was continuous and severe.

Intermittent, spontaneous pain is characterised as shooting, stabbing, electric shock-like, or searing and is often evoked by stimuli that normally do not cause pain, for example touch, the weight of bed covers, chewing or a cold breeze

Steady neurogenic pain is typified by burning, tingling, tight or band-like sensations, aching and throbbing. This type of pain is often worse at night, worse during temperature change and worsened by exercise.

Then there is tissue damage which may result from disability. This can be secondary to musculoskeletal changes in MS due to weakness or incorrect posture for example. If a person walks in a different way than normal then joints may be stressed and become painful as well.

How can MS pain be treated?

Pain management is approached medically, behaviourally, physically and in some cases, surgically. If it is treated with drugs it is always a balance of risk versus benefit. In other words, medication side effects need to be considered and continually evaluated in terms of their impact on a person’s quality of life.

It is not the remit of this article to identify the drugs used.

Emotional Effects

It is important to recognise the emotional effects of experiencing pain and to develop healthy coping strategies.

Some examples are:

•    Learn relaxation and meditation skills.
•    Concentrate on positive thoughts and activities.
•    Talk to a counsellor.
•    Seek assistance from an MS Society Field Worker or an MS nurse.
•    Contact a support group for people with chronic pain.

In addition some suggestions for managing pain include:

•    Exercising gently and regularly, but only within your limits.
•    Modifying your environment (e.g. comfortable bedding).
•    Considering equipment that may prevent pain from being triggered (e.g. a gripping stick to avoid having to reach).
•    Treating flare-ups as they occur – delay can cause problems.
•    Seeing a physiotherapist regularly.

In future articles I will address the current options in treatment of MS pain

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