Symptomatic Treatment of MS - European Multiple Sclerosis Platform

MS-RELATED PAIN SYNDROMES
The frequency of clinically relevant pain is reported by up to 86% of MS patients. MS-related pain may
be classified into four main categories:
� Directly MS-related pain: acute optic neuritis, headache due to a demyelinating lesion within the
brainstem or cervical spinal cord, pseudoradicular pain; paroxysmal syndromes (trigeminal and other
neuralgias including radicular pain syndromes, paroxysmal dystonia with painful muscle spasms,
Lhermitte´s sign); chronic painful dysaesthesia and paraesthesia; thalamic pain
� Pain as indirect sequel of other MS symptoms: Joint and muscle related pain due to long standing
abnormal posture, spasticity, contractures, pressure sores, decubital ulcer; visceral pain; peripheral
nerve lesions due to chronic pressure, e.g. poorly fitted ortheses.
� Pain following drug treatment, especially beta-interferons
� MS-independent pain: Chronic low back pain in the realm of degenerative spinal column diseases;
osteoporosis, or primary headaches.
The limitation of this categorization lies in the fact that some of these pain syndromes, e.g. low back
pain, may be classified into more than one group.
Most evidence-based studies on pain treatments used today in MS-related pain syndromes have been
investigated in neuropathic and nociceptive pain resulting from other diseases than MS. Duration,
severity, accompanying symptoms, triggers and treatments used should be documented within a pain
diary. Severity of pain may be estimated using a visual analogue scale. Treatment is aimed at reducing
pain resulting in lesser restriction of mobility, ability and psychosocial sequels, and thus ameliorating
quality of life.
SPECIFIC TREATMENT
The mode of treatment depends on the type of pain the patient presents and therefore its exact differentiation
is crucial. Whenever possible physiotherapy and occupational therapy should be used since
they suggest an “active action against pain”. If development of chronic pain is impending an additive
psychological treatment within a multimodal overall plan is indicated.
DIRECTLY MS-RELATED PAIN:
In acute optic neuritis, intravenous corticosteroids are indicated [MSTCG 2004] and are known to reduce
pain within a short time. For treatment recommendations of neuralgias and paroxysmal dystonia see
section on„Paroxysmal symptoms“.
Directly MS-related chronic pain often presents with unpleasant „burning“ dysaesthesias of arms,
legs, or trunk. They may be bilaterally and asymmetrical. This neuropathic pain is present in different
neurological disorders and can be alleviated effectively by tricyclic antidepressants like amitryptiline
11 EMSP, Symptomatic Treatment of Multiple Sclerosis, December 2006 - revised in April 2008