Table of ContentsView AllTable of ContentsSpasticityLhermitte’s SignMuscles and MobilityOther Possible Causes
Table of ContentsView All
View All
Table of Contents
Spasticity
Lhermitte’s Sign
Muscles and Mobility
Other Possible Causes
Low back pain is very common in the general population, but even more so among people withmultiple sclerosis (MS). Though many with MS share this aspect of their disease experience,whythey do can vary, as causes range from physical changes (such as uncontrolled muscle contractions) to practical challenges (like those related to mobility).
It’s also possible for people with MS to experience what healthcare providers call “mixed pain,” meaning more than one MS process is causing their low back discomfort.
In addition to the physical challenges of MS recent research indicates that fatigue and mental health conditions such as depression and anxiety are closely associated with significant pain in people with MS.
Likewise, research has shown that lifestyle factors which people with MS and those supporting them can address are also associated with pain.These include tobacco use, fatigue, and an unhealthy diet and insufficient exercise—both of which can contribute to obesity.
The most effective course of treatment must be tailored based on what exactly is responsible for the pain. Research indicates that the percentage of people with MS who experience low back pain could be as high a 41.6%.Addressing both mental health and modifiable lifestyle factors can help to reduce or preventpain in people with multiple sclerosis.
Verywell / Jessica Olah
Spasticity tends to vary from person to person, like othersymptoms of MS. For instance, a person may notice a mild tightening of his or her legs that does not affect daily functioning. Others may experience severe leg spasticity that causes painful cramping that interferes with movement.
While spasticity most commonly affects a person’s calves, thighs, groin, and buttocks, it can also cause tightening and aching in and around the joints and lower back.
Prevention and Treatment
Treatment of spasticity that affects your lower back usually entails a combination of both medication and physical therapy.These therapies may include:
Avoiding triggers is, of course, an important way to prevent worsening of your spasticity in your lower back. Examples of triggers that may irritate your spasticity include:
People whose spasticity does not respond to the above may require one or more of the following treatments.
FDA approved medications are:
There are other medications that can be used “off label” for treatment in specific situations. These include:
One classic cause of back pain in multiple sclerosis is a phenomenon calledLhermitte’s sign, which refers to a shock-like sensation or a “wave of electricity” that moves rapidly from the back of a person’s head down through their spine.
This sensation occurs when a person bends their neck forward (for example, when removing a necklace or tying their shoes). The sensation is short-lived and goes away once a person moves their head back up.
Lhermitte’s sign is due toMS lesionsin the cervical spine, the neck region of the spinal column or backbone.
Prevention
Certain medications, such as the anti-seizure drug called Neurontin (gabapentin) can help prevent the pain from occurring in the first place. Neurontin is generally reserved for those who find Lhermitte’s sign to be debilitating.
Muscle and Mobility Problems
Another culprit for low back pain in MS is related to issues stemming from immobility. For instance, if a person with MS is using their cane or anothermobility-assistive deviceimproperly, low back pain may develop.
In order to compensate for an MS-related issue like a numb or tingling leg or foot, a person’s gait may be impaired, or they may distribute their weight unnaturally, which can put a strain on the lower back. Sitting in a wheelchair all day can also put excess pressure on one’s back.
Strategies to prevent or combat these musculoskeletal causes of low back pain include:
Nonsteroidal anti-inflammatories (NSAIDs) can also be helpful in the short-term to relieve acute inflammation. That said, be sure to talk to your healthcare provider before taking one. NSAIDs can cause kidney, liver, heart, or stomach problems and are not safe or appropriate for everyone.
Living With Multiple Sclerosis
When MS Is Not the Cause
It’s important to note that a lot of people experience low back pain, regardless of whether or not they have MS. This is why it’s essential to undergo a proper diagnosis for your low back pain and not just assume it’s from your disease.
Examples of common causes of low back pain in the general population include:
Much less common, but more serious causes of lower back pain include:
MS vs. Ankylosing Spondylitis: What Are the Differences?
Finally, sometimes a person thinks their pain stems from their lower back when it’s actuallyreferred pain, meaning the source of the pain is not in the muscles and ligaments of the back.
Examples of sources of referred pain include:
A Word From Verywell
Lower back pain can be debilitating and it may take some trial and error to find the right treatment, but in most cases your healthcare provider can find ways to help you feel better, both physically and mentally.
Be upfront about your pain, how it has progressed, and what seems to make it worse, and be sure to mention any other symptoms you are experiencing, even if they seem unrelated.
9 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.Scherder R, Kant N, Wolf E, Pijnenburg B, Scherder E.Psychiatric and physical comorbidities and pain in patients with multiple sclerosis.J Pain Res. 2018;11:325-334. doi.10.2147/JPR.S146717Marck C, De livera A, Weiland T, et al.Pain in people with multiple sclerosis: associations with modifiable lifestyle factors, fatigue, depression, anxiety, and mental health quality of life.Front Neurol. 2017;8:461. doi:10.3389/fneur.2017.00461Massot C, Agnani O, Khenioui H, Hautecoeur P, Guyot M, et al.Back pain and musculoskeletal disorders in multiple sclerosis.J Spine. 2016;5:285. doi:10.4172/2165-7939.1000285Milinis K, Tennant A, Young C.Spasticity in multiple sclerosis: Associations with impairments and overall quality of life.Mult Scler Relat Disord. 2016;5:34-9. doi:10.1016/j.msard.2015.10.007Holland N, Stockwell S.Controlling spasticity in MS, National Multiple Sclerosis Society.Khare S, Seth D.Lhermitte’s sign: the current status.Ann Indian Acad Neurol. 2015;18(2):154-6. doi.10.4103/0972-2327.150622Bethoux F, Bennett S.Introduction: Enhancing mobility in multiple sclerosis.Int J MS Care. 2011;13(1):1-3. doi.10.7224/1537-2073-13.1.1Rudroff T, Sosnoff J.Cannabidiol to improve mobility in people with multiple sclerosis.Front Neurol. 2018;9:183. doi.10.3389/fneur.2018.00183Allegri M, Montella S, Salici F, et al.Mechanisms of low back pain: a guide for diagnosis and therapy.F1000Res. 2016;5. doi.10.12688/f1000research.8105.2Additional ReadingFoley et al.Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis.Pain. 2013 May;154(5):632-42. doi: 10.1016/j.pain.2012.12.002Maloni H. (2016). National MS Society.Pain in Multiple Sclerosis. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/PainTruini A, Barbant P, Pozzilli C, Cruccu G.A mechanism-based classification of pain in multiple sclerosis.J Neurol.2013 Feb;260(2):351-67. doi: 10.1007/s00415-012-6579-2
9 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.Scherder R, Kant N, Wolf E, Pijnenburg B, Scherder E.Psychiatric and physical comorbidities and pain in patients with multiple sclerosis.J Pain Res. 2018;11:325-334. doi.10.2147/JPR.S146717Marck C, De livera A, Weiland T, et al.Pain in people with multiple sclerosis: associations with modifiable lifestyle factors, fatigue, depression, anxiety, and mental health quality of life.Front Neurol. 2017;8:461. doi:10.3389/fneur.2017.00461Massot C, Agnani O, Khenioui H, Hautecoeur P, Guyot M, et al.Back pain and musculoskeletal disorders in multiple sclerosis.J Spine. 2016;5:285. doi:10.4172/2165-7939.1000285Milinis K, Tennant A, Young C.Spasticity in multiple sclerosis: Associations with impairments and overall quality of life.Mult Scler Relat Disord. 2016;5:34-9. doi:10.1016/j.msard.2015.10.007Holland N, Stockwell S.Controlling spasticity in MS, National Multiple Sclerosis Society.Khare S, Seth D.Lhermitte’s sign: the current status.Ann Indian Acad Neurol. 2015;18(2):154-6. doi.10.4103/0972-2327.150622Bethoux F, Bennett S.Introduction: Enhancing mobility in multiple sclerosis.Int J MS Care. 2011;13(1):1-3. doi.10.7224/1537-2073-13.1.1Rudroff T, Sosnoff J.Cannabidiol to improve mobility in people with multiple sclerosis.Front Neurol. 2018;9:183. doi.10.3389/fneur.2018.00183Allegri M, Montella S, Salici F, et al.Mechanisms of low back pain: a guide for diagnosis and therapy.F1000Res. 2016;5. doi.10.12688/f1000research.8105.2Additional ReadingFoley et al.Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis.Pain. 2013 May;154(5):632-42. doi: 10.1016/j.pain.2012.12.002Maloni H. (2016). National MS Society.Pain in Multiple Sclerosis. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/PainTruini A, Barbant P, Pozzilli C, Cruccu G.A mechanism-based classification of pain in multiple sclerosis.J Neurol.2013 Feb;260(2):351-67. doi: 10.1007/s00415-012-6579-2
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.
Scherder R, Kant N, Wolf E, Pijnenburg B, Scherder E.Psychiatric and physical comorbidities and pain in patients with multiple sclerosis.J Pain Res. 2018;11:325-334. doi.10.2147/JPR.S146717Marck C, De livera A, Weiland T, et al.Pain in people with multiple sclerosis: associations with modifiable lifestyle factors, fatigue, depression, anxiety, and mental health quality of life.Front Neurol. 2017;8:461. doi:10.3389/fneur.2017.00461Massot C, Agnani O, Khenioui H, Hautecoeur P, Guyot M, et al.Back pain and musculoskeletal disorders in multiple sclerosis.J Spine. 2016;5:285. doi:10.4172/2165-7939.1000285Milinis K, Tennant A, Young C.Spasticity in multiple sclerosis: Associations with impairments and overall quality of life.Mult Scler Relat Disord. 2016;5:34-9. doi:10.1016/j.msard.2015.10.007Holland N, Stockwell S.Controlling spasticity in MS, National Multiple Sclerosis Society.Khare S, Seth D.Lhermitte’s sign: the current status.Ann Indian Acad Neurol. 2015;18(2):154-6. doi.10.4103/0972-2327.150622Bethoux F, Bennett S.Introduction: Enhancing mobility in multiple sclerosis.Int J MS Care. 2011;13(1):1-3. doi.10.7224/1537-2073-13.1.1Rudroff T, Sosnoff J.Cannabidiol to improve mobility in people with multiple sclerosis.Front Neurol. 2018;9:183. doi.10.3389/fneur.2018.00183Allegri M, Montella S, Salici F, et al.Mechanisms of low back pain: a guide for diagnosis and therapy.F1000Res. 2016;5. doi.10.12688/f1000research.8105.2
Scherder R, Kant N, Wolf E, Pijnenburg B, Scherder E.Psychiatric and physical comorbidities and pain in patients with multiple sclerosis.J Pain Res. 2018;11:325-334. doi.10.2147/JPR.S146717
Marck C, De livera A, Weiland T, et al.Pain in people with multiple sclerosis: associations with modifiable lifestyle factors, fatigue, depression, anxiety, and mental health quality of life.Front Neurol. 2017;8:461. doi:10.3389/fneur.2017.00461
Massot C, Agnani O, Khenioui H, Hautecoeur P, Guyot M, et al.Back pain and musculoskeletal disorders in multiple sclerosis.J Spine. 2016;5:285. doi:10.4172/2165-7939.1000285
Milinis K, Tennant A, Young C.Spasticity in multiple sclerosis: Associations with impairments and overall quality of life.Mult Scler Relat Disord. 2016;5:34-9. doi:10.1016/j.msard.2015.10.007
Holland N, Stockwell S.Controlling spasticity in MS, National Multiple Sclerosis Society.
Khare S, Seth D.Lhermitte’s sign: the current status.Ann Indian Acad Neurol. 2015;18(2):154-6. doi.10.4103/0972-2327.150622
Bethoux F, Bennett S.Introduction: Enhancing mobility in multiple sclerosis.Int J MS Care. 2011;13(1):1-3. doi.10.7224/1537-2073-13.1.1
Rudroff T, Sosnoff J.Cannabidiol to improve mobility in people with multiple sclerosis.Front Neurol. 2018;9:183. doi.10.3389/fneur.2018.00183
Allegri M, Montella S, Salici F, et al.Mechanisms of low back pain: a guide for diagnosis and therapy.F1000Res. 2016;5. doi.10.12688/f1000research.8105.2
Foley et al.Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis.Pain. 2013 May;154(5):632-42. doi: 10.1016/j.pain.2012.12.002Maloni H. (2016). National MS Society.Pain in Multiple Sclerosis. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/PainTruini A, Barbant P, Pozzilli C, Cruccu G.A mechanism-based classification of pain in multiple sclerosis.J Neurol.2013 Feb;260(2):351-67. doi: 10.1007/s00415-012-6579-2
Foley et al.Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis.Pain. 2013 May;154(5):632-42. doi: 10.1016/j.pain.2012.12.002
Maloni H. (2016). National MS Society.Pain in Multiple Sclerosis. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain
Truini A, Barbant P, Pozzilli C, Cruccu G.A mechanism-based classification of pain in multiple sclerosis.J Neurol.2013 Feb;260(2):351-67. doi: 10.1007/s00415-012-6579-2
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