How Is Pain Treated
How your pain is treated will depend on the cause and severity of the pain. This means that you need a thorough assessment to decide whether the pain is nerve pain, muscle pain or might be due to causes other than MS. Assessment may be carried out by a neurologist, MS nurse, physiotherapist, or occupational therapist, amongst others, depending on the type of pain and the likely choice of treatment. You may be referred to a pain clinic to see the specialist pain team.
Treating pain often means trying several treatments one after the other, or perhaps at the same time, to see what works best for you. You have a role to play, not only in following the advice of your health professionals about treatments, but in making changes to your daily life to minimise your pain and its effects on you. Your health professionals should review your treatment regularly and suggest alternatives if something is not working well.
It may not be possible to get rid of your pain completely so it may be a case of managing it as well as possible to reduce its impact on everyday life.
Drug Treatments For Nerve Pain
Not all nerve pain will be treated, for example, numbness and loss of sensation may not be treated unless they are causing particular distress.
The National Institute for Health and Care Excellence has issued guidelines for the treatment of nerve pain. As common painkillers are not effective against nerve pain, NICE 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, as pain is different for each person, health professionals may recommend different options depending on what may be best for you as an individual.
With any treatment, there is the possibility of side effects so these should be discussed. Many side effects wear off or can be managed effectively. For example, if a medication makes you sleepy, it may be best to take it last thing at night. This way it could act as a positive in helping you sleep if your nights rest has been disrupted by pain.
The guidelines also suggest that you and your health professional should agree a treatment plan that takes into account your concerns and expectations. Your treatment should be reviewed regularly and, if a drug is not working well enough, one of the others should be tried.
Although, nerve pain can usually be improved with drug treatments, it is often best to take other steps to managing the pain yourself .
Symptom Series: Types Of Ms Pain
Understanding an invisible MS symptom
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Multiple sclerosis affects everyone differently. No two people have the exact same symptoms or experiences with the disease. Since MS affects the nerve cells in the brain and spinal cord, you may have a wide range of symptoms. Some are visible and can be seen by others. Others are invisible and are only seen or felt by the person with MS.
Through our MS Symptom Series, well provide some information and tips about different symptoms to discuss with your healthcare team. Remember, your healthcare team should be your primary source for information or any questions.
Pain is often referred to as an invisible symptom of multiple sclerosis . Unlike other MS symptoms, pain cannot always be seen. Someone sitting next to you may not know your leg is aching from your MS because you may appear fine. Everybody experiences pain differently, so how do you begin to describe it? While pain is a physical MS symptom, it can also have an emotional impact. But there are ways to help handle that, starting with open communication.
Over half of people living with MS have reported pain as a significant symptom. For people with MS, pain is often categorized by how long it lasts. When the pain is of short duration it is referred to as acute. When the pain is long lasting and persistent, it is considered chronic.
There are two types of pain that people with MS may experience:
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Multiple Sclerosis Symptoms In The Knees
Multiple sclerosis is a physically debilitating disease that is still not fully understood by doctors 3. The most likely cause is the accidental destruction of nerves in the brain and spinal cord by the patient’s own immune system. This damage to the nerves results in the destruction of the outer myelin coating of nerves, which normally insulates the nerve cells and allows them to transmit signal between the brain and the body. Multiple sclerosis may cause many different symptoms, including symptoms affecting the knees 3.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Early Warning Signs Of Multiple Sclerosis
Multiple sclerosis, like a lot of the other autoimmune diseases has a range of symptoms.
The symptoms and their severity that fluctuates from person to person. Some of the more common early warning signs include tingling and numbness in different parts of your body.
A person might feel like an electrical current is running down their arm, legs or neck. Someone they might have generalize weakness.
A person might experience difficulty with walking. They may have blurry vision and sometimes they might see double.
They can have urinary urgency, or perhaps difficulty when they begin urinating.
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My Osteoarthritis Has Progressed
My knee pain and disability have gotten worse again, so I went back to my doctor. This time the x-rays showed that my OA has progressed significantly. I officially have lost enough cartilage, and a portion of my bones are touching in my right knee and my left knee is not much better. The doctor agreed to try the hyaluronic acid injections again, but he was clear that we will need to change the discussion to total knee replacement if and when this treatment doesnt work.
My Ms Is Getting To Be A Pain Literally
For most of the 36 years since I was diagnosed with multiple sclerosis Ive not been bothered by pain. Just lucky, I guess. Until last month. Suddenly, Ive developed pain in both hips and I dont know why.
The pain is most intense when I first put my feet on the ground, either getting out of bed in the morning or sliding off a wooden stool to a standing position after breakfast in the kitchen. Its worse if Im standing or walking on a hard surface, such as tile, and in bare feet. Its less intense as I walk, using my two canes. And its hard to notice it at all, right now, as Im writing this sitting at my desk on a comfortable leather chair, feet on the ground with good back support.
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What Does Ms Pain Feel Like
Multiple sclerosis can be very painful. So for many people with MS, it’s difficult to believe that as recently as the 1980s, MS was considered a painless condition. In fact, it’s estimated that around 80% of people with MS experience pain related to their disease at some point in their life.
Pain in MS is complicated. To better understand it, let’s divide it into the following three categories:
- Neuropathic pain
People With Ms May Experience Pain For Other Reasons Including:
- as a side effect of medication eg headaches or injection site reactions to disease modifying treatments
- as a result of infections, such as a bladder infection
- from an accident or other health condition not related to MS
It is common to experience more than one type of pain.
Treating MS pain may include drugs or non-drug treatments, such as physiotherapy. You can also make changes to your everyday life so that pain has less impact. Effective pain management often means trying a range of approaches to see which ones work best for you and then adopting several at once to get the best overall effect.
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Musculoskeletal Or Secondary Pain
Also called nociceptive pain, this is usually a result of the symptoms of MS, such as spasticity, weakness, immobility or problems walking, and not the disease process itself. Some examples of this are:
- Joint pain: Many people with MS feel pain in the joints of the hips and knees due to imbalance and a change in gait.
- Stiffness: A person with MS may experience stiffness in the legs, arms, and hips due to immobility.
- Back pain: Back pain can be the result of an unsteady gait, immobility, trying to adapt to the annoying feeling of the MS hug, sitting for extended periods in wheelchairs or any constant adjustment in movement or position as a result of MS symptoms.
- Pain from spasms: Flexor spasms cause a limb to contract, or bend, towards the body. This can make the limb feel like it has a constant cramp or dull ache.
Examples Of Musculoskeletal Pain Are:
- Hip and back pain caused by alterations in how you walk due to MS, possibly because of muscle stiffness , weakness or problems with balance.
- Back pain due to sitting for long periods because of fatigue, walking difficulties or inability to stand for long.
- Muscle or joint pain due to changes in posture, spasms or muscle stiffness
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A Question For My Orthopedist
The next time that I visit my orthopedist I know what one of my questions will be: Have you successfully completed total knee replacement surgery on a person with MS and what was their outcome?
The more I think about it, the more nervous I become. But once the osteoarthritis pain and disability has progressed to a point where I cant manage it anymore, something will need to be done.
Whats your experience? As a person with MS, have you undergone a total joint replacement? If so, what was the outcome? Please share your story in the comments below.
Read my other articles on MultipleSclerosis.net
Leg And Hip Pain Associated With Multiple Sclerosis: Types Of Pain And How To Alleviate And Prevent Them
Multiple sclerosis can cause two major types of pain in the hips and legs. The musculoskeletal pain can affect the entire body, but the hips and legs seem to be affected most often. Chronic neurogenic pain is the most common type of pain in multiple sclerosis patients and typically occurs in the legs.
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Steroid Injections In My Knees Followed By Hyaluronic Acid
In the years since that first steroid injection, Ive consulted with the same orthopedist a number of times. While my osteoarthritis remained mild, treatment consisted of steroid injections in each knee at different times. When my OA progressed to a moderate stage, my orthopedist offered a different type of injectable treatment option: a series of hyaluronic acid. Both knees received this treatment at different times. These injections made such a positive difference that I didnt need to see my doctor for years between attacks.
Some Of The More Common Descriptions Include:
You may have a totally different description for your pain. Nerve pain is particularly difficult to describe and people with MS sometimes worry that they wont be believed or they are going mad. However, pain and unusual sensations are common in MS and treatment should be discussed with your health professionals in the same way as for any other symptom.
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What Causes Muscle Spasms In Multiple Sclerosis
Multiple sclerosis is an autoimmune disease that affects the nervous system. What happens is your own bodys immune system destroy its own tissue, known as the myelin sheath. This is the important tissue that covers the spinal cord and the nerve receptors.
These attacks leave behind open areas known as lesson. Its these lesion areas that causes abnormalities in the electrical signals sent to and from the brain.
These irregular impulses are what causes the numerous symptoms associated with MS.
In this article Ill discuss the three types of muscle spasms what problems each one causes and the available treatment options.
What Does Osteoarthritis Have To Do With My Ms
One of my more noticeable MS symptoms is spasticity. It is something I spend a lot of time trying to manage through medication, modified activity, intentional stretching, and gentle movement. Ive found that cycling has helped both my spasticity and the arthritis in my knees in recent years. Additional MS symptoms that fluctuate include weakness in the legs and impaired balance. A portion of the testing for these symptoms include gait analysis.
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Intraoperative Care And Postoperative Planning
Our patient had significant lateral compartment contracture at the time of her surgery. Because the future stability of the knee is also a concern, it would seem reasonable to avoid tendon releases if possible. In our patient, sufficient range of motion was achieved without tendon releases however, she later developed severe contractures. Possibly targeting the lateral hamstrings with botulinum intraoperatively or earlier in the postoperative period may have prevented the contracture formation.
To ensure stability of the TKA, Rao et al. recommended in their case report a fixed-bearing posterior-stabilized prosthesis. A more constrained prosthesis in patients with severe spasticity may reduce the risk of dislocation. Although this was not needed for our patient, a previous dislocation was reported by Bron et al. .
While the recommended duration of treatment for thromboembolism prophylaxis is 10-35 days for general TKA populations , , as patients with MS may be slower to mobilize, we suggest that longer durations be considered. Although continuous passive motion devices may not be routine care in general orthopaedic TKA practices , these devices may have a role for patients with MS at higher risk for complications related to immobility.
What Triggers Autoimmune Diseases
The most common explanation is that an affected persons immune system, partly due to the genes they inherited, is primed to react abnormally to some trigger, such as an infection, an environmental exposure , or some other factor. For most autoimmune diseases, we cant easily figure out what triggers them. If we could, we might be able to prevent them.
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What Is An Autoimmune Disease
Autoimmune diseases develop when a persons immune system goes after its own tissues and organs. Autoimmune disease can affect all parts of the body. For example:
- Type 1 diabetes. This is the type that usually affects kids and develops when abnormal antibodies attack certain cells in the pancreas, leaving it unable to produce enough insulin, so the body cant regulate blood sugar properly
- Rheumatoid arthritis. Multiple joints and other organs become inflamed the cause is unknown, but the presence of autoantibodies and other abnormal immune function suggest it is an autoimmune disorder.
- Pernicious anemia. In this condition, anemia develops when the immune system produces antibodies that prevent absorption of vitamin B12 from food.
And these are just a few. Autoimmune conditions are especially scary because the immune system goes rogue for no apparent reason.
Ms Muscle Spasticity: What It Is And What To Do About It
Spasticity related to MS can range from mild stiffness to painful muscle spasms. Stretching is one of the best ways to manage it.
The holistic health and spirituality teacher tries to engage in physical exercise mostly yoga and light weight training at the gym every day to help manage her symptoms.
Still, she says, You never know how your day is going to be. Some days, I wake up and feel great and cant wait to get to the gym. Then there are other days I fall as soon as I get out of bed, either because of the pain or because I just dont have the strength in my legs.
The symptoms of muscle weakness and pain Ciganovich experiences can be traced to one of the hallmark symptoms of multiple sclerosis: spasticity.
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The Connection Between Hip And Knee Pain
When were in pain and go to the doctor to find out whats wrong, were often surprised to learn that the area in question isnt a cause for concern. This is because all of our body parts are interconnected and work together to keep us alive. Often, if your knee hurts, your hip will as well, and vice versa!
Pain in the hips and/or knees may be caused by the joints themselves, or it may be the result of an underlying condition in another part of the body.
Your hip is a ball-and-socket joint that works to support the weight of your upper body, relying on a variety of muscles and tissues to keep it mobile and stable so it can function properly.
Your knee is a hinge joint that can only move forward and backward. When you squat, your knees support six times your body weight more than your hips. Proper hip and knee movement allow you to perform complex movements such as standing, walking, running, and dancing without falling over.
The hips and knees are part of the same kinetic chain, which means they are a group of weight-bearing joints that must work in unison for the body to function properly.
As a result, issues with your knees can lead to issues with your hips, and vice versa. Stress and deterioration may be placed on another part of the kinetic chain if one part of the chain is out of balance. Its all intertwined!