Pain was not previously seen as a symptom of MS. Although neurologists included numbness, tingling, itching, and many other sensory symptoms within the broad spectrum of MS symptoms, they often excluded pain from this classification.

Doctors have realized over the past several years that pain is not only one of the symptoms of MS, but that it may be one of the most important symptoms in some patients, and the main reason for the patient’s feeling of aggravation of his condition and lack of effectiveness in daily life. . In fact, some studies have shown that a quarter of patients with MS suffer from persistent pain that affects their lives in one way or another.

In 1973, the International Society for the Study of Pain defined pain as an “experience with sensory and psychological consequences”. Studies have long established the significant influence of social and psychological factors on a patient’s perception of pain, and therefore of the resulting disability. In addition, it is possible to predict the duration of the pain when knowing its severity and its impact on the patient’s activity and mood. Knowing such pathogens can be useful in developing an appropriate plan for early therapeutic intervention.

It is known today that pain has a complex pathophysiology, where the signals sent from the extremities to the brain and vice versa are affected by the individual’s psychological status to a large extent. Central nervousness, opioid hyperalgesia, psychological status, anticipation of future pain, past experiences, repeated exposure to nociceptive stimuli, and prior exposure to trauma. It is worth noting that the physical sensory component is no less important than the psychological component of pain and the patient’s suffering from it.

What are the forms of pain that accompany MS?
There are many forms of pain that may accompany MS, including the following:

Trigeminal neuralgia – Trigeminal neuralgia syndrome is common among patients with MS, and appears in the form of electrical tingling pain on one side of the face, specifically on the cheek. The pain may appear several times a day, be severe and last for a few seconds. It is worth noting that this pain can be triggered by touching the face, when the face is exposed to a breath of air, or even when chewing. In the treatment of trigeminal neuralgia, drugs that affect nerve functions such as carbamazepine, phenytoin, lamotrigine, Neurontin, Lyrica and others are used in the treatment of trigeminal neuralgia. In some cases, some surgical procedures can be used to treat this pain, such as pressing the nerve with a catheter tube connected to a balloon to numb it, or heating the nerve using an electric current. This pain can also be treated by directing a beam of radiation directly onto the nerve.
Burning pain in the extremities – This is a second form of pain, and it may appear in any area of ​​the body but most often affects the legs. This pain continues and increases in intensity at night, and the person with this pain shows a high sensitivity to touch at times, and may feel cold in the affected limb at other times. This can be explained by changes in sensory signals in the spinal cord and brain as a result of the breakdown of the myelin sheath surrounding nerve fibers.

Burning pain in the extremities can be treated by some types of effective antidepressants such as Nortriptyline, and some anticonvulsants such as carbamazepine and gabapentin and others. In addition to the above. Duloxetine hydrochloride has been approved for the treatment of peripheral nerve pain, as it can be used for all pain associated with multiple sclerosis, and tramadol can be used. Sometimes long-acting medications are needed to treat pain. It should be noted that physical activities such as exercise and stretching may also be effective, and lidocaine patches with local anesthesia can be used to relieve pain in severe cases.
Neck and back pain – Some people with MS experience back and neck pain as a result of lack of movement or the normal stress that many people without the disease experience. This pain is described as a stiff, painful sensation that can be severe. It is important to perform diagnostic imaging to rule out other causes that may be behind this pain, such as lumbar disc disease. Anti-inflammatories may be an effective treatment to relieve this pain. Stretching, water aerobics, and other natural procedures may help in treating the pain.
Other sources of pain – some patients develop a condition in the shoulder or hip as a result of being treated with steroids in the past. Taking steroids frequently may change the amount of blood that feeds the shoulder or hip joints in some cases, and may end up damaging them, sometimes requiring joint replacement surgery. In cases of severe damage. This damage shows up on X-rays or magnetic resonance images. Because many other disorders cause pain, it’s important to consider other sources of pain during diagnosis and not just blame MS.


Are there additional actions the patient can take?
Regular stretching and exercise helps relieve many forms of pain, especially back pain and muscle pain, and helps relieve fatigue and raise the patient’s morale. The patient should have sufficient and comfortable sleep. On the other hand, some patients find benefit in alternative methods of pain management such as acupuncture and cognitive-behavioral therapy, and psychophysiological techniques for managing pain and stress such as biofeedback, relaxation training and self-hypnosis.

In cases where it is difficult to control the pain, the patient can join one of the official programs specialized in pain management, and it is necessary to monitor the pattern and frequency of defecation in the patient in the event of taking pain relievers that cause constipation, which increases the patient’s feeling of malaise.