Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, which consists of the brain, the spinal cord and the optic nerves. Multiple sclerosis affects women twice as often as men, and the exact cause is unknown. MS is usually diagnosed in early adulthood, and most cases are diagnosed between ages 20 and 50. However, MS can also occur in adolescence or even early childhood, according to the National Multiple Sclerosis Society. There are treatments available, but there is no cure for MS.
The Facts
In people who have multiple sclerosis, the immune system attacks the nerve cells or neurons, in the brain and/or spinal cord. Neurons consist of a cell body, which receives impulses from other neurons and that produces impulses, and an axon, which is attached to the cell body and which carries the impulses to other neurons. All of the nervous tissue in the body, including the brain and spinal cord, functions through this communication between neurons.
Many neurons have multiple layers of a protein and lipid substance surrounding their axons---this substance is called myelin. The neurons that have myelin are referred to as "myelinated" neurons, and the myelin that surrounds their axons is called a myelin sheath. The myelin sheath protects the axon. The immune system of a person who has MS attacks the myelin sheaths, producing scars or plaques, which are also called scleroses. The destruction of myelin interferes with, and can eventually destroy, the neuron's ability to send signals to other neurons. The scar tissue is permanent, and damaged neurons cannot be repaired. When an area of the brain, spinal cord or optic nerves is filled with neurons that are not able to communicate well with other neurons, that part of the brain or spinal cord cannot function properly.
The symptoms of MS vary from person to person and depend on many factors, including which areas of the central nervous system are damaged by the disease. Some common symptoms are vision problems, weakness, fatigue and numbness or tingling sensations in various parts of the body, which are called paresthesias.
Pain
According to the National Multiple Sclerosis Society, about 55 percent of MS sufferers report "clinically significant" pain at some point during the disease process, and pain with MS is about twice as common in women as in men. Pain can be acute or chronic, and can be neuropathic---which means it is caused by malfunctioning neurons---or have another cause.
Trigeminal neuralgia is one type of acute neuropathic pain. It is named for the trigeminal nerve, which is responsible for sensation in the face. Trigeminal neuralgia pain is a sharp, stabbing pain to the side of the face that is the result of damage to the trigeminal nerve, and it can be quite severe. Sometimes trigeminal neuralgia is one of the first symptoms of MS. Because it is in the side of the face, trigeminal neuralgia is sometimes mistaken for tooth pain.
L'Hermitte's sign (pronounced "lair-meet") is a brief, sudden sensation of electric shock, buzzing or pain that travels down the body as a result of bending the neck forward. It is a type of paresthesia, or abnormal sensation. It can be associated with a number of disorders, including cervical spondylosis, arthritis, tumors or pernicious anemia. In MS it is a result of damage to the cervical spine, which is the neck region of the spine, and is classified as neuropathic pain. About two-thirds of MS sufferers experience L'Hermitte's sign at some time.
MS sufferers can also experience tingling, burning, aching or "girdling" which is a sometimes painful band-like pressure around the body. Physicians call these symptoms "dysesthesias," which means an unpleasant abnormal sensation. These dysesthesias are neuropathic, and can either be acute or chronic in MS sufferers. Although not common, sometimes neuropathic pain can accompany optic neuritis, causing pain when the eye is moved according to the Multiple Sclerosis Society of Scotland.
Some pain associated with MS is not neuropathic. Examples include pain resulting from muscle spasticity, or back pain associated with the immobility some MS sufferers experience. Although this pain is just as real and important as neuropathic pain, the treatment is different.
Treatments
While there is no cure for MS, there are treatments available. Some treatments can alter the course of the disease or slow its progression. Other treatments can ease the symptoms of MS, including neuropathic pain.
Neuropathic pain does not respond well to medications that are used to treat other types of pain, such as pain resulting from an injury, so doctors must take a different approach when treating it. Trigeminal neuralgia is often treated with anticonvulsant medications such as carbamazepine (Tegretol®) or phenytoin (Dilantin®). For L'Hermitte's sign, doctors may prescribe an anticonvulsant drug or soft-collar support for the neck if this symptom is severe enough to interfere with daily life. Dysethesias such as burning, aching or girdling are often treated with the anticonvulsant gabapentin (Neurontin®) or the antidepressant amitriptyline. The antidepressant duloxetine hydrochloride (Cymbalta®), although not specifically for MS, has been approved for the treatment of diabetic neuropathy and therefore may help with neuropathic pain in MS sufferers. Antidepressants help ease neuropathic pain by changing the way the brain responds to the pain signals coming from the damaged nerve cells. The drug pregabalin (Lyrica®), which the FDA approved in 2004 for treating neuropathic pain associated with diabetes and fibromyalgia, can also help some MS sufferers who experience neuropathic pain. Dysesthesias are also sometimes treated by non-chemical means, such as wearing a pressure stocking or using a warm compress on the affected area. Acetaminophen (Tylenol®) also sometimes eases the pain of dysesthesias, according to the National Multiple Sclerosis Society.
Non-neuropathic pain in MS responds to different treatments. Pain from muscle spasticity can be treated with baclofen (Lioresal®) or tizanidine (Zanaflex®), anti-inflammatory drugs such as ibuprofen, or stretching exercises. Back pain caused by immobility can be treated with ultrasound, physical therapy or heat.
Considerations
While some symptoms of MS, such as weakness or difficulty walking, can be obvious, pain is an invisible symptom. A person who suffers from chronic, debilitating pain can look "just fine" to others but feel terrible and have problems functioning. It is important for MS sufferers who experience pain to communicate with their loved ones about how they are feeling, so that they may offer support. Chronic pain can also interfere with an MS sufferer's ability to work or perform other activities, and can cause great emotional distress. Some MS sufferers find that it helps to talk about it; your local chapter of The National Multiple Sclerosis Society can tell you about support groups in your area.
It is very important to tell your physician about any symptoms you are experiencing, including pain. Physicians have a variety of options for helping you with pain, and asking for help is not "whining" or a sign of weakness. If a treatment your physician has prescribed for your pain is not working, tell her so she can try something else. The National Multiple Sclerosis Society also recommends multidisciplinary pain clinics for MS sufferers who experience chronic pain; these clinics can offer a variety of treatments such as medications, physical therapy, counseling, and alternative treatments.
Warning
A change in symptoms or the appearance of new symptoms in MS sufferers can sometimes indicate a change in the course of the disease or an adverse reaction to medications. Contact your physician if your symptoms change.
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