Pain and Multiple Sclerosis (cont.)
Some of the most common types of pain experienced by multiple sclerosis patients include:
Acute MS pain. These come on suddenly and may go away suddenly. They are often intense but can be brief in duration. The description of these acute pain syndromes are sometimes referred to as burning, tingling, shooting, or stabbing.
Trigeminal neuralgia or "tic doloureux." A stabbing pain in the face that can be brought on by almost any facial movement, such as chewing, yawning, sneezing, or washing your face. People with MS typically confuse it with dental pain. Most people can get sudden attacks of pain that can be triggered by touch, chewing, or even brushing the teeth.
Lhermitte's sign. A brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward.
Burning, aching, or "girdling" around the body. This is called dysesthesia by physicians.
There are also some types of pain related to MS that are described as being chronic in nature -- lasting for more than a month -- including pain from spasticity that can lead to muscle cramps, tight and aching joints, and back or musculoskeletal pain. These chronic pain syndromes can often be relieved by anti-inflammatory drugs, massage, and physical therapy.
Anticonvulsant Drugs Offer Relief
For the most part, however, acute MS pain can't be effectively treated with aspirin, ibuprofen, or other common OTC pain reliever medications or treatments. "Since most MS pain originates in the central nervous system, it makes it a lot more difficult to control than joint or muscle pain," says Kathleen Hawker, MD, an assistant professor of neurology in the multiple sclerosis program at the University of Texas Southwestern Medical Center in Dallas (UTSW).
So what's the alternative? In many cases, the treatment of choice is one of a range of anticonvulsant medications, such as Neurontin and Tegretol. "The main thing that links them all up is that we're not quite sure how they work -- either for seizures or for pain," says Hawker. Since the FDA hasn't officially approved these anticonvulsants for the treatment of pain, they're all being used "off-label," but Neurontin, for example, is prescribed five times more often for pain than for seizures, says Hawker.
"In the vast majority of patients, these medications do work," says George Kraft, who directs the Multiple Sclerosis Rehabilitation, Research, and Training Center and the Western Multiple Sclerosis Center at the University of Washington in Seattle. "There's a problem, though, in that most of them can make people sleepy, groggy, or fatigued, and MS patients have a lot of fatigue anyway."