Multiple sclerosis (MS)—an autoimmune disease that leads to damage to the myelin coating around nerve fibers—causes symptoms such as fatigue, weakness or numbness in the limbs, tremors, unsteady gait, and tingling or pain in different areas of the body. Pain, including neck and back pain, is a common symptom that can be acute or chronic. While currently there is no cure for MS, there are treatments to help slow the progression of the disease and manage pain and other related symptoms.
Treatment of Spasticity
If you suffer chronic back and musculoskeletal pain caused by spasticity, your doctor may recommend the use of nonsteroidal anti-inflammatory medications to help relieve pain. Anti-inflammatory drugs block the cyclooxygenase (COX) enzymes found in muscle tissue that produces prostaglandins, or lipid compounds, which contribute to inflammation and pain. Prostaglandins not only affect the inflammatory process, but they also can act on nerves, increasing sensitivity to pain or changing your perception of it.
Doctors also use corticosteroids, such as oral prednisone, to reduce nerve inflammation that can cause pain and stiffness that may eventually become disabling. These drugs suppress chronic inflammation and relieve pain but can cause all kinds of side effects, particularly if you take them over a long period of time. Your doctor will discuss with you ways in which you can minimize the side effects.
Reduction in Muscle Spasm Pain
When over-the-counter painkillers aren’t enough to ease the tightness, pain, and aching joints associated with MS, prescription muscle relaxants help reduce painful spasms by relaxing muscle tension. These drugs work by depressing the central nervous system to relieve muscle spasms that cause low back pain and spasticity in the upper and lower limbs. Depending on the specific medication your doctor prescribes, a muscle relaxant may work on muscles directly or block nerve pathways to prevent pain messages traveling up the spinal cord from reaching the brain.
Nerve Pain Relief
Individuals with MS often feel painful sensations known as dysesthesias in their feet, legs, trunk, and arms. Dysesthesias, which are caused by sensory or peripheral nerve damage, cause a tingling sensation, burning, or severe aching pain. Doctors sometimes recommend antidepressants to treat this type of MS pain.
Your doctor may also prescribe anti-seizure medication to treat burning or stabbing pain caused by nerve damage. Although it isn’t completely understood how anti-seizure medications work to calm nerve pain, the drugs may interfere with the pain signals that damaged nerves send to the spinal cord and brain. Doctors often prescribe this class of medications to treat trigeminal neuralgia—facial pain that many individuals with MS experience.
Treatment for Advanced MS Symptoms
If you have relapsing-remitting or rapidly progressing MS, you may receive drugs injected intravenously by a health care provider.
Mitoxantrone, a chemotherapy drug to treat cancer, is an immunosuppressant that can reduce the symptoms of MS. However, because of the potential for serious side effects, doctors generally only use the drug to treat individuals with severe, advanced MS.
Doctors more commonly prescribe beta interferons, which are injected under the skin, to treat the symptoms of MS. A health care professional may inject the medication or instruct you on how to inject yourself at home. Liver damage is a possible side effect of the drug; therefore, your doctor will monitor your liver enzymes.
Alemtuzumab is a drug doctors use to reduce inflammation and limit damage to nerve cells. The drug depletes the number of white blood cells in the body, which can attack the myelin sheath on the nerves, causing nerve damage. Chronic inflammation can trigger the release of white blood cells when an inflammatory response isn’t required, leading to attack on healthy tissues and cells.
Additional Treatment Options to Consider
Medications are not the only options available for fighting the pain associated with MS. You may consider alternative therapies in addition to traditional drug treatments for MS. Check with the doctors managing your MS before beginning an alternative therapy for chronic pain.
Biofeedback therapy is one alternative therapy for managing pain. Electromyography (EMG) biofeedback, which measures muscle tension and electrical activity in the muscles, may help reduce MS-related stiffness and pain. Through sensors attached to your body, EMG monitors muscle activity. As part of the therapy, a biofeedback therapist instructs you in practicing different relaxation techniques such as deep breathing, progressive muscle relaxation, and visualization to help you relax.
Exercise, in general, is good for the body. Regular physical activity not only helps you sleep better, but it can help relieve back, neck, and muscle pain. Water aerobics, yoga, recumbent bicycling, and the use of an exercise ball are low-impact exercises that help decrease muscle tension and increase range of motion to reduce pain.
Regular stretching and flexibility exercises as part of a physical therapy program, therapeutic ultrasound, and heat therapy are additional treatment modalities to help relieve pain and muscle stiffness related to MS. Heat therapy increases blood flow to an area, helping to reduce muscle spasm. Ultrasound therapy works in a similar way.
For more advice on treatments for managing chronic pain related to MS, contact the team of professionals at Southwest Florida Neurosurgical & Rehab Associates.