This article will discuss the various treatment options for managing MS pain, including prescription medications, over-the-counter (OTC) drugs, and non-drug pain management options such as physical therapy, exercise, and alternative medicine.
Types of MS Pain
There are many types of MS pain. Understanding how the disease causes pain and the ways to treat it can help you manage symptoms of the disease.
MS pain can be caused by the disease itself, or other symptoms of the disease that may lead to pain. For example, if you experience weakness in your leg, the way you walk (gait) could be affected, which may put pressure on other joints causing knee, hip, or back pain.
There are three types of MS pain: neuropathic, musculoskeletal, and pain caused by spasticity. You may experience all of these types of pain at once, or you may go through flares (times when you deal with one type of severe pain more than the others).
Neuropathic Pain
Neuropathic pain refers to pain caused by changes to the nervous system. Usually, this type of pain occurs when lesions form on the brain or spinal cord due to the disease process. Neuropathic pain can be one of the most difficult to treat.
With neuropathic pain, you may experience:
Numbness Tingling Aching in the limbs Trigeminal neuralgia, a condition that affects the main nerve of the face, causing sudden and severe pain Lhermitte’s sign, an MS symptom that causes an electric shock-like feeling down the neck that spreads to the body when moving the head
Neuropathic pain can occur without any reason or can be triggered by things that would normally not cause pain, such as a light touch.
Experiencing neuropathic pain can also lead to other symptoms such as fatigue, depression, and difficulty sleeping. Carrying out physical or mental tasks can become more difficult as well.
Musculoskeletal Pain
Musculoskeletal pain refers to pain that occurs in the muscles, bones, joints, tendons, and ligaments. In MS, this type of pain usually occurs in the neck, wrists, and knees, but it can also manifest as back pain or pain in the elbows, shoulders, hips, or ankles.
Spasticity Pain
Spasticity is a tightening of the muscles that interferes with movement. With spasticity, the legs, arms, or back may stiffen or become tight. You may feel cramping as well. This can make it difficult to move around, and it causes pain not only in the area that is experiencing spasticity but in adjacent areas as well.
Prescription Pain Management
Prescription pain medications can be used to treat all types of MS pain. These medications include muscle relaxants, antidepressants, and antiepileptics.
Muscle Relaxants
Muscle relaxants are used to treat spasticity and the pain surrounding the tightening of the muscles.
These include but are not limited to:
Baclofen (tablet, oral solution, or via a spinal pump system) TizanidineDiazepamClonazepamDantrolene
Side effects of muscle relaxants like baclofen can include dizziness, weakness, headache, confusion, nausea, tiredness, and constipation. Talk to your healthcare provider if any of these interfere with your daily life.
Antidepressants
Tricyclic antidepressants like amitriptyline are often the first choice for treating neuropathic pain.
These include but are not limited to:
Amitriptyline Doxepin Imipramine
While antidepressants can help treat neuropathic pain, they can also treat depression associated with MS at the same time. Taking an antidepressant can help with both symptoms.
The side effects for antidepressants include drowsiness, dry mouth, constipation, low blood pressure, and difficulty fully emptying your bladder.
Antiepileptics
Antiepileptics, sometimes known as anticonvulsants, can help with certain types of neuropathic pain, like that which occurs with trigeminal neuralgia and Lhermitte’s sign.
These include but are not limited to:
Clonazepam Gabapentin Carbamazepine
Side effects of antiepileptics like gabapentin include drowsiness, dizziness, headache, increased appetite, weight gain, and tiredness.
If you are taking an antiepileptic, it’s important to talk to your healthcare provider or pharmacist about possible side effects.
Warnings and Interactions
While some of these medications may safely be prescribed at the same time, it’s important to follow your healthcare provider’s treatment plan to avoid any adverse reactions from the combination of drugs.
It is common for people with MS to be prescribed five or more medications at a time. In addition to treating your MS pain, you may also be on disease-modifying therapies (DMTs) and other medications for symptom management.
Taking several drugs that work by acting on your central nervous system can cause sedation, dizziness, and difficulty with cognition or thinking.
If there is anything you don’t understand about your treatment plan, it’s essential that you ask questions. Also, talk to your healthcare provider if you experience any negative side effects that affect your daily life.
OTC Pain Management
Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), like Aleve (naproxen) and Advil (ibuprofen), can treat musculoskeletal pain and headaches common with MS.
These medications can relieve pain and lower inflammation in the body, which can also help with the pain associated with MS.
While these medications are quite helpful at relieving painful symptoms that are not caused by nerve pain, they do carry risks. Long-term use of NSAIDs can cause gastrointestinal bleeding.
If you are using NSAIDs on a frequent basis, you should talk to your healthcare provider to make sure that you are not causing damage to your body.
Non-Drug Pain Management
In addition to medication, there are other steps you can take to help manage the pain from MS.
Many people turn to complementary and alternative medicine (CAM) practices, such as acupuncture and massage, to help relieve symptoms.
In some areas, cannabis has been approved to treat pain and spasticity in MS. However, there is no scientific evidence that using cannabis helps people with MS. Due to restrictive laws, studies on cannabis have not been extensive.
One study did find that people who remained active and at a healthy weight experienced less pain from their MS. If you are having difficulty starting or returning to an exercise regimen, a physical therapist can help you manage movement in a way that makes sense for your body and your course of MS.
Living with MS requires a fine balance between engaging in activities that make you feel better, such as exercise, stretching, and eating healthy, and finding the motivation to do those things when you’re in pain.
A Word From Verywell
Living with the unpredictability of MS can be difficult, but knowing your treatment options can help you manage your condition. When you’re in the middle of a painful flare, you might not be able to see your way out of it. However, understanding your pain management options ahead of time can help you prepare for when the pain recurs. Talk to your healthcare provider about the best treatment options for you.
This may make it difficult for you to start or continue healthy habits like eating well and exercising. Create a plan with your healthcare provider to stay active while managing MS pain.
