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Living Well with MS

What is Pain?

Everyone experiences pain differently – “Pain is whatever the experiencing person says it is, existing whenever they say it does”. McCaffery 1969.

Pain is an uncomfortable feeling that tells you something may be wrong. It can be steady, throbbing, stabbing, aching, pinching, or described in many other ways. Sometimes, it's just a nuisance, like a mild headache. Other times it can be debilitating. It can be short- or long-term and stay in one place or spread around the body.

Describing Pain:

An individual’s description of the pain will help identify the type of pain, so we may ask the individual to describe:

The character of pain, such as what does it feel like?
The site, quality, any radiation of pain: meaning where you feel the pain and how far it seems to have spread?
What factors aggravate and relieve the pain?
The times at which pain occurs throughout the day?
Its effect on the person’s daily function and mood?

The above diagram is what we would use to measure a persons pain - VAS (Visual Analogue Scale)

Types of pain and causes in multiple sclerosis:

Nerve pain (neuropathic pain) - Which is caused by damage to the nerves in the brain and spinal cord. This includes altered sensations such as pins and needles, numbness, crawling or burning feelings. Examples of nerve pain include painful sensations in the side of the face, called trigeminal neuralgia, and a tight feeling, often around the chest, called the MS hug. Pain in the limbs is very common.
Musculoskeletal pain - which is caused by damage to muscles, tendons, ligaments and soft tissue, for example neck or back pain caused by changes in posture or sitting for very long periods.

How To Manage Pain?

It is a very common symptom in MS, however over time it may affect what you can do, ability to work and sleep patterns. It can have a strong negative effect on family and friends too.

Pain signals use the spinal cord and specialised nerve fibres to travel to your brain. Part of this process is linked directly with the emotional centres in the brain. This means how you are feeling has an effect on your pain. If you feel angry, depressed or anxious, your pain will be worse.

The opposite is also true. If you are feeling positive and happy, your pain can seem to be less and able to cope much better.

It shows that pain is never "just in the mind" or “just in the body” - it is a complex mix and how the brain interpretation the signals. This mix can change from one day to the next.

Treating Pain:

Some people prefer non drug treatments as there is less worry about side effects. Therefore other ways to try and manage could be worth a try:-

- Exercise Lack of activity and exercise, due to pain or other symptoms, can cause a gradual loss of strength and fitness. This is called deconditioning and can make your pain worse. Although it may not sound appealing, regular exercise can reverse deconditioning and help ease your pain.

-Heat Although heat sensitivity makes MS symptoms worse for many people, heat applied to the affected area can be helpful.

-Cold Some people find that applying ice or a cold pack helps. Ice should be wrapped in a tea towel not applied straight to the skin or you could try a pack of frozen peas.

-Relaxation There are many relaxation techniques which can help you so it can be worth trying a range to see what suits you best. You could try breathing exercises, massage, mindfulness, meditation, hypnotherapy or gentle yoga stretching exercises.

-TENS Transcutaneous electrical nerve stimulation is the application of a small electric current. It can be used in the management of some types of pain in multiple sclerosis

Common painkillers are not effective against nerve pain, therefore NICE (National Institute for Health and Care Excellence) recommends that people with MS should try amitriptyline, duloxetine, gabapentin or pregabalin first. Treatment usually starts with a low dose and then builds up slowly until an effective dose is reached.

However Musculoskeletal pain may be helped by common pain relieving drugs such as paracetamol, ibuprofen or aspirin. If the pain is due to muscle stiffness (spasticity), then treatments for spasticity may be offered.

We are also able to refer to Herefordshire Pain self-management service

The service offers 1:1 and group appointments as well as telephone or video call appointments. Our Pain Self-Management Clinics are run at Sarum House in St Ethelbert Street, Hereford. The team includes a pain management nurse prescriber, physiotherapist, and clinical psychologist and is supported by the Pain Clinic Consultants in Wye Valley NHS Trust and Gloucestershire Hospitals NHS Trust. For more info https://www.wyevalley.nhs.uk/services/community-services/pain-management-service.aspx