Table of ContentsView AllTable of ContentsTypes of MS PainPain FrequencyPain SeverityManaging MS PainFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Types of MS Pain
Pain Frequency
Pain Severity
Managing MS Pain
Frequently Asked Questions
Pain is a potential symptom ofmultiple sclerosis (MS)that can significantly interfere with a person’s ability to function and enjoy life. Multiple sclerosis is an autoimmune condition in which the immune system mistakenly attacks the sheath that protects nerve fibers in the central nervous system (CNS).
In this article, we’ll discuss the two main types of pain found in MS. We’ll also review how MS pain can be effectively managed under the care and guidance of your healthcare provider.
Anupong Thongchan / EyeEm / Getty Images
To best understand and treat pain in MS, experts have categorized this symptom into these two main types:
Neuropathic Pain
In MS, a person’s immune system attacks the nerve fibers and the protectivemyelinsheath that surrounds them within their central nervous system. Your CNS is composed of your brain and spinal cord.
When nerve fibers or myelin are damaged, nerve signaling between the CNS and the rest of the body is impaired. This can lead to an array of symptoms, including fatigue, blurry vision, mobility issues, and pain—specifically, neuropathic pain.
One common type of MS-associated neuropathic pain isdysesthesia. This is a skin sensation that is uncomfortable or painful and often described as burning, tingling, itching, stinging, or crawling feelings.
Dysesthesia can range in severity from being a mild nuisance to debilitating, interfering with a person’s sleep and ability to work. They are chronic pains, meaning they tend to be long lasting and not typically associated with an MSrelapse.
What Is an MS Relapse?
Other forms of neuropathic pain in MS are acute. Pain usually begins suddenly and can be part of an MS relapse.
Common examples of acuteneuropathic painin MS include:
Musculoskeletal Pain
For example, you may walk a certain way if you have a weak or numb foot. Over time, your compensated gait can put abnormal stress on certain muscles and joints, like those in your hip, causing pain.
Likewise, if you have fatigue or mobility issues, you may develop lower back pain from sitting for extended periods. Inactivity can also contribute to poor posture and weakness, which may then lead to neck pain and falls, respectively.
Spasticityis another MS symptom. With spasticity, your muscles become tight or abnormally stiff as a result of MS-related damage within the pathways that carry motor (movement) signals.
While muscle spasms and tightening can be painful, spasticity may also aggravate your joints as the muscles surrounding them are pulled or tugged.Spasticity can also cause you to alter your gait or position in a wheelchair, resulting in muscle overuse, injury, and/or pain.
How Often Does MS Cause Pain?
Research suggests pain affects anywhere between 30% and 80% of patients living with MS.This percentage range is likely broad because pain is a subjective, unique experience, which can make it difficult to measure.
Not everyone with MS has pain. For those who do, the severity varies considerably.
In some cases, MS-related pain can be intermittent and managed well with relatively simple measures like applying a cold compress, stretching, or temporarily using amobility assistive device(e.g., brace or scooter).
For others though, their pain may significantly affect their quality of life. Pain may prevent them from sleeping well, working, or performing household tasks.
Unfortunately, the negative impact of pain can then snowball into more problems, including social isolation,depression, and worsening of other MS symptoms (e.g., fatigue and immobility).
When devising your pain management plan, your MS provider will consider several factors like the type and severity of your pain and whether it’s acute or chronic. Personal preference and your response to previous pain management therapies are also key considerations.
Pharmacological Therapies
There are several classes of medications used to treat MS pain.
Neuropathic painmay be treated with drugs that help calm down nerve firing. Such drugs include:
Musculoskeletal paincan be soothed with an over-the-counter (OTC) pain medication like Tylenol (acetaminophen) ornonsteroidal anti-inflammatory drugs (NSAIDs)like Motrin or Advil (ibuprofen).
Are Tylenol and Motrin Safe for Everyone?Tylenol and Motrin (and other NSAIDs) should be avoided or used cautiously in people with certain medical conditions. Always talk with your healthcare provider before taking any medication.
Are Tylenol and Motrin Safe for Everyone?
Tylenol and Motrin (and other NSAIDs) should be avoided or used cautiously in people with certain medical conditions. Always talk with your healthcare provider before taking any medication.
If the pain is related tospasticity, a muscle relaxant like Kemstro (baclofen) or Zanaflex (tizanidine) may be prescribed. Baclofen is unique in that it can also be administered intrathecally (delivered directly into your spinal fluid using a pump device).
Botox (onabotulinumtoxin A)injections may also help decrease spasticity in MS.
What to Know About Multiple Sclerosis (MS) Pain Medication
Complementary Therapies
In addition to medication, various complementary therapies may help ease MS-related pain.
Examples of such therapies are:
Other complementary therapies you may consider for soothing your pain includeyoga,aquatic (water) therapy,physical therapy,hypnosis, andmeditation.
Be mindful that choosing the right combination of therapies is often a trial and error process. It may take some time as you sort through what treatments help you feel better and what fits into your lifestyle.
How Multiple Sclerosis Is Treated
Summary
The management of pain in MS typically involves a combination of medication and complementary therapies.
A Word From Verywell
Managing MS pain requires an individualized approach. When talking with your neurologist or other MS healthcare provider about your pain, try to explain as much as you can about your pain—how it feels, where it’s located, and how severe it is. Giving examples of how your pain affects your daily routine or mood is often helpful.
Also, it’s important to not assume that any pain in your body is from MS. There may be something else going on. Be sure to seek medical care for any new, persistent, or severe pain.
Research suggests that psychosocial factors like having a negative belief about pain or avoiding activity may affect the severity of a person’s pain and how it interferes with their daily functioning.
MS pain can occur throughout the body, including the skin, face, arms, hands, legs, feet, and trunk.
Research suggests that exercise can help alleviate pain in patients with MS. If you have MS-related pain, it’s best to talk with your MS healthcare provider or physical therapist to ensure your exercise regimen is safe and beneficial for you.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National MS Society.Pain and Itching.Khan N, Smith MT.Multiple sclerosis-induced neuropathic pain: pharmacological management and pathophysiological insights from rodent EAE models.Inflammopharmacology.2014;22(1):1-22. doi:10.1007/s10787-013-0195-3Shumway NK, Cole E, Fernandez KH.Neurocutaneous disease: neurocutaneous dysesthesias.J Am Acad Dermatol. 2016;74(2):215-28; quiz 229-30. doi:10.1016/j.jaad.2015.04.059Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065Prosperini L, Castelli L.Spotlight on postural control in patients with multiple sclerosis.Degener Neurol Neuromuscul Dis. 2018;8:25–34. doi:10.2147/DNND.S135755American Association of Neurological Surgeons.Spasticity.Urits I, Adamian L, Fiocchi J et al.Advances in the understanding and management of chronic pain in multiple sclerosis: a comprehensive review.Curr Pain Headache Rep.2019;23(8):59. doi:10.1007/s11916-019-0800-2Kahraman T, Özdoğar AT, Ertekin O, Özakbaş S.Frequency, type, distribution of pain and related factors in persons with multiple sclerosis. 2019;28:221-225. doi:10.1016/j.msard.2019.01.002Chisari CG, Sgarlata E, Arena S, D’Amico E, Toscano S, Patti F.An update on the pharmacological management of pain in patients with multiple sclerosis. 2020;21(18):2249-2263. doi:10.1080/14656566.2020.1757649Khodaie F, Abbasi N, Motlasgh AHK, Zhao B, Moghadasi AN.Acupuncture for multiple sclerosis: A literature review.Mult Scler Relat Disord.2022;60:103715. doi:10.1016/j.msard.2022.103715Salarvand S, Heidari ME, Farahi K, Teymuri E, Almasian M, Bitaraf S.Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis.Mult Scler J Exp Transl Clin.2021;7(2):20552173211022779. doi:10.1177/20552173211022779Rice J, Cameron M.Cannabinoids for treatment of MS symptoms: state of the evidence.Curr Neurol Neurosci Rep.2018;18(8):50. doi:10.1007/s11910-018-0859-xHarrison AM, Silber E, McCracken LM, Moss-Morris R.Beyond a physical symptom: the importance of psychosocial factors in multiple sclerosis pain.Eur J Neurol. 2015;22(11):1443-52. doi:10.1111/ene.12763Demaneuf T, Aitken Z, Karahalios A.Effectiveness of exercise interventions for pain reduction in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.Arch Phys Med Rehabil.2019;100(1):128-139. doi:10.1016/j.apmr.2018.08.178
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National MS Society.Pain and Itching.Khan N, Smith MT.Multiple sclerosis-induced neuropathic pain: pharmacological management and pathophysiological insights from rodent EAE models.Inflammopharmacology.2014;22(1):1-22. doi:10.1007/s10787-013-0195-3Shumway NK, Cole E, Fernandez KH.Neurocutaneous disease: neurocutaneous dysesthesias.J Am Acad Dermatol. 2016;74(2):215-28; quiz 229-30. doi:10.1016/j.jaad.2015.04.059Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065Prosperini L, Castelli L.Spotlight on postural control in patients with multiple sclerosis.Degener Neurol Neuromuscul Dis. 2018;8:25–34. doi:10.2147/DNND.S135755American Association of Neurological Surgeons.Spasticity.Urits I, Adamian L, Fiocchi J et al.Advances in the understanding and management of chronic pain in multiple sclerosis: a comprehensive review.Curr Pain Headache Rep.2019;23(8):59. doi:10.1007/s11916-019-0800-2Kahraman T, Özdoğar AT, Ertekin O, Özakbaş S.Frequency, type, distribution of pain and related factors in persons with multiple sclerosis. 2019;28:221-225. doi:10.1016/j.msard.2019.01.002Chisari CG, Sgarlata E, Arena S, D’Amico E, Toscano S, Patti F.An update on the pharmacological management of pain in patients with multiple sclerosis. 2020;21(18):2249-2263. doi:10.1080/14656566.2020.1757649Khodaie F, Abbasi N, Motlasgh AHK, Zhao B, Moghadasi AN.Acupuncture for multiple sclerosis: A literature review.Mult Scler Relat Disord.2022;60:103715. doi:10.1016/j.msard.2022.103715Salarvand S, Heidari ME, Farahi K, Teymuri E, Almasian M, Bitaraf S.Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis.Mult Scler J Exp Transl Clin.2021;7(2):20552173211022779. doi:10.1177/20552173211022779Rice J, Cameron M.Cannabinoids for treatment of MS symptoms: state of the evidence.Curr Neurol Neurosci Rep.2018;18(8):50. doi:10.1007/s11910-018-0859-xHarrison AM, Silber E, McCracken LM, Moss-Morris R.Beyond a physical symptom: the importance of psychosocial factors in multiple sclerosis pain.Eur J Neurol. 2015;22(11):1443-52. doi:10.1111/ene.12763Demaneuf T, Aitken Z, Karahalios A.Effectiveness of exercise interventions for pain reduction in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.Arch Phys Med Rehabil.2019;100(1):128-139. doi:10.1016/j.apmr.2018.08.178
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National MS Society.Pain and Itching.Khan N, Smith MT.Multiple sclerosis-induced neuropathic pain: pharmacological management and pathophysiological insights from rodent EAE models.Inflammopharmacology.2014;22(1):1-22. doi:10.1007/s10787-013-0195-3Shumway NK, Cole E, Fernandez KH.Neurocutaneous disease: neurocutaneous dysesthesias.J Am Acad Dermatol. 2016;74(2):215-28; quiz 229-30. doi:10.1016/j.jaad.2015.04.059Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065Prosperini L, Castelli L.Spotlight on postural control in patients with multiple sclerosis.Degener Neurol Neuromuscul Dis. 2018;8:25–34. doi:10.2147/DNND.S135755American Association of Neurological Surgeons.Spasticity.Urits I, Adamian L, Fiocchi J et al.Advances in the understanding and management of chronic pain in multiple sclerosis: a comprehensive review.Curr Pain Headache Rep.2019;23(8):59. doi:10.1007/s11916-019-0800-2Kahraman T, Özdoğar AT, Ertekin O, Özakbaş S.Frequency, type, distribution of pain and related factors in persons with multiple sclerosis. 2019;28:221-225. doi:10.1016/j.msard.2019.01.002Chisari CG, Sgarlata E, Arena S, D’Amico E, Toscano S, Patti F.An update on the pharmacological management of pain in patients with multiple sclerosis. 2020;21(18):2249-2263. doi:10.1080/14656566.2020.1757649Khodaie F, Abbasi N, Motlasgh AHK, Zhao B, Moghadasi AN.Acupuncture for multiple sclerosis: A literature review.Mult Scler Relat Disord.2022;60:103715. doi:10.1016/j.msard.2022.103715Salarvand S, Heidari ME, Farahi K, Teymuri E, Almasian M, Bitaraf S.Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis.Mult Scler J Exp Transl Clin.2021;7(2):20552173211022779. doi:10.1177/20552173211022779Rice J, Cameron M.Cannabinoids for treatment of MS symptoms: state of the evidence.Curr Neurol Neurosci Rep.2018;18(8):50. doi:10.1007/s11910-018-0859-xHarrison AM, Silber E, McCracken LM, Moss-Morris R.Beyond a physical symptom: the importance of psychosocial factors in multiple sclerosis pain.Eur J Neurol. 2015;22(11):1443-52. doi:10.1111/ene.12763Demaneuf T, Aitken Z, Karahalios A.Effectiveness of exercise interventions for pain reduction in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.Arch Phys Med Rehabil.2019;100(1):128-139. doi:10.1016/j.apmr.2018.08.178
National MS Society.Pain and Itching.
Khan N, Smith MT.Multiple sclerosis-induced neuropathic pain: pharmacological management and pathophysiological insights from rodent EAE models.Inflammopharmacology.2014;22(1):1-22. doi:10.1007/s10787-013-0195-3
Shumway NK, Cole E, Fernandez KH.Neurocutaneous disease: neurocutaneous dysesthesias.J Am Acad Dermatol. 2016;74(2):215-28; quiz 229-30. doi:10.1016/j.jaad.2015.04.059
Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131
Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065
Prosperini L, Castelli L.Spotlight on postural control in patients with multiple sclerosis.Degener Neurol Neuromuscul Dis. 2018;8:25–34. doi:10.2147/DNND.S135755
American Association of Neurological Surgeons.Spasticity.
Urits I, Adamian L, Fiocchi J et al.Advances in the understanding and management of chronic pain in multiple sclerosis: a comprehensive review.Curr Pain Headache Rep.2019;23(8):59. doi:10.1007/s11916-019-0800-2
Kahraman T, Özdoğar AT, Ertekin O, Özakbaş S.Frequency, type, distribution of pain and related factors in persons with multiple sclerosis. 2019;28:221-225. doi:10.1016/j.msard.2019.01.002
Chisari CG, Sgarlata E, Arena S, D’Amico E, Toscano S, Patti F.An update on the pharmacological management of pain in patients with multiple sclerosis. 2020;21(18):2249-2263. doi:10.1080/14656566.2020.1757649
Khodaie F, Abbasi N, Motlasgh AHK, Zhao B, Moghadasi AN.Acupuncture for multiple sclerosis: A literature review.Mult Scler Relat Disord.2022;60:103715. doi:10.1016/j.msard.2022.103715
Salarvand S, Heidari ME, Farahi K, Teymuri E, Almasian M, Bitaraf S.Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis.Mult Scler J Exp Transl Clin.2021;7(2):20552173211022779. doi:10.1177/20552173211022779
Rice J, Cameron M.Cannabinoids for treatment of MS symptoms: state of the evidence.Curr Neurol Neurosci Rep.2018;18(8):50. doi:10.1007/s11910-018-0859-x
Harrison AM, Silber E, McCracken LM, Moss-Morris R.Beyond a physical symptom: the importance of psychosocial factors in multiple sclerosis pain.Eur J Neurol. 2015;22(11):1443-52. doi:10.1111/ene.12763
Demaneuf T, Aitken Z, Karahalios A.Effectiveness of exercise interventions for pain reduction in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.Arch Phys Med Rehabil.2019;100(1):128-139. doi:10.1016/j.apmr.2018.08.178
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