Chronic pain is one of the most common symptoms of multiple sclerosis (MS), an autoimmune disease in which your immune system attacks the protective covering of nerve fibers called the myelin sheath. Chronic pain can affect your quality of life, making it hard to complete everyday tasks. It may also affect your mental health. Living with chronic pain can be difficult since it is invisible and often hard to explain to others. Everyone with MS experiences pain differently.

This article will discuss the various treatment options for managing MS pain, including prescription medications, over-the-counter (OTC) drugs, and non-drug pain management options such as physical therapy, exercise, and alternative medicine.

Types of MS Pain

There are many types of MS pain. Understanding how the disease causes pain and the ways to treat it can help you manage symptoms of the disease.

MS pain can be caused by the disease itself, or other symptoms of the disease that may lead to pain. For example, if you experience weakness in your leg, the way you walk (gait) could be affected, which may put pressure on other joints causing knee, hip, or back pain.

There are three types of MS pain: neuropathic, musculoskeletal, and pain caused by spasticity. You may experience all of these types of pain at once, or you may go through flares (times when you deal with one type of severe pain more than the others).

Neuropathic Pain

Neuropathic pain refers to pain caused by changes to the nervous system. Usually, this type of pain occurs when lesions form on the brain or spinal cord due to the disease process. Neuropathic pain can be one of the most difficult to treat.

With neuropathic pain, you may experience:

  • Numbness
  • Tingling
  • Aching in the limbs
  • Trigeminal neuralgia, a condition that affects the main nerve of the face, causing sudden and severe pain
  • Lhermitte’s sign, an MS symptom that causes an electric shock-like feeling down the neck that spreads to the body when moving the head

Neuropathic pain can occur without any reason or can be triggered by things that would normally not cause pain, such as a light touch.

Experiencing neuropathic pain can also lead to other symptoms such as fatigue, depression, and difficulty sleeping. Carrying out physical or mental tasks can become more difficult as well.

Musculoskeletal Pain

Musculoskeletal pain refers to pain that occurs in the muscles, bones, joints, tendons, and ligaments. In MS, this type of pain usually occurs in the neck, wrists, and knees, but it can also manifest as back pain or pain in the elbows, shoulders, hips, or ankles.

Spasticity Pain

Spasticity is a tightening of the muscles that interferes with movement. With spasticity, the legs, arms, or back may stiffen or become tight. You may feel cramping as well. This can make it difficult to move around, and it causes pain not only in the area that is experiencing spasticity but in adjacent areas as well.

Prescription Pain Management

Prescription pain medications can be used to treat all types of MS pain. These medications include muscle relaxants, antidepressants, and antiepileptics.

Muscle Relaxants

Muscle relaxants are used to treat spasticity and the pain surrounding the tightening of the muscles.

These include but are not limited to:

  • Baclofen (tablet, oral solution, or via a spinal pump system) TizanidineDiazepamClonazepamDantrolene

Side effects of muscle relaxants like baclofen can include dizziness, weakness, headache, confusion, nausea, tiredness, and constipation. Talk to your healthcare provider if any of these interfere with your daily life.

Antidepressants

Tricyclic antidepressants like amitriptyline are often the first choice for treating neuropathic pain.

  • Amitriptyline
  • Doxepin
  • Imipramine

While antidepressants can help treat neuropathic pain, they can also treat depression associated with MS at the same time. Taking an antidepressant can help with both symptoms.

The side effects for antidepressants include drowsiness, dry mouth, constipation, low blood pressure, and difficulty fully emptying your bladder.

Antiepileptics

Antiepileptics, sometimes known as anticonvulsants, can help with certain types of neuropathic pain, like that which occurs with trigeminal neuralgia and Lhermitte’s sign.

MS and Depression

Research has found that pain and depression can amplify one another. So, if you are in pain, your chances of having depression symptoms increase, and vice versa. Treating them both at once can help with the pain cycle.

  • Clonazepam
  • Gabapentin
  • Carbamazepine

Side effects of antiepileptics like gabapentin include drowsiness, dizziness, headache, increased appetite, weight gain, and tiredness.

If you are taking an antiepileptic, it’s important to talk to your healthcare provider or pharmacist about possible side effects.

Warnings and Interactions

While some of these medications may safely be prescribed at the same time, it’s important to follow your healthcare provider’s treatment plan to avoid any adverse reactions from the combination of drugs.

It is common for people with MS to be prescribed five or more medications at a time. In addition to treating your MS pain, you may also be on disease-modifying therapies (DMTs) and other medications for symptom management.

Taking several drugs that work by acting on your central nervous system can cause sedation, dizziness, and difficulty with cognition or thinking.

If there is anything you don’t understand about your treatment plan, it’s essential that you ask questions. Also, talk to your healthcare provider if you experience any negative side effects that affect your daily life.

OTC Pain Management

Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), like Aleve (naproxen) and Advil (ibuprofen), can treat musculoskeletal pain and headaches common with MS.

These medications can relieve pain and lower inflammation in the body, which can also help with the pain associated with MS.

While these medications are quite helpful at relieving painful symptoms that are not caused by nerve pain, they do carry risks. Long-term use of NSAIDs can cause gastrointestinal bleeding.

If you are using NSAIDs on a frequent basis, you should talk to your healthcare provider to make sure that you are not causing damage to your body.

Non-Drug Pain Management 

In addition to medication, there are other steps you can take to help manage the pain from MS.

Many people turn to complementary and alternative medicine (CAM) practices, such as acupuncture and massage, to help relieve symptoms.

In some areas, cannabis has been approved to treat pain and spasticity in MS. However, there is no scientific evidence that using cannabis helps people with MS. Due to restrictive laws, studies on cannabis have not been extensive.

One study did find that people who remained active and at a healthy weight experienced less pain from their MS. If you are having difficulty starting or returning to an exercise regimen, a physical therapist can help you manage movement in a way that makes sense for your body and your course of MS.

Living with MS requires a fine balance between engaging in activities that make you feel better, such as exercise, stretching, and eating healthy, and finding the motivation to do those things when you’re in pain.

A Word From Verywell

Living with the unpredictability of MS can be difficult, but knowing your treatment options can help you manage your condition. When you’re in the middle of a painful flare, you might not be able to see your way out of it. However, understanding your pain management options ahead of time can help you prepare for when the pain recurs. Talk to your healthcare provider about the best treatment options for you.

Managing the Fine Line of Pain

Living with pain can cause other symptoms, such as fatigue and depression, which can in turn make the pain worse. This can cause a cycle in which, because you’re in pain, you develop fatigue or depression, and because you’re depressed, your pain intensifies. When the pain intensifies, so does the fatigue and depression, and you’re less motivated to remain active.

Frequently Asked Questions

  • What does MS pain feel like?
  • MS pain varies for everyone. You may experience dull aches due to the changes to your body caused by MS, or you could experience sharp, sudden pain caused by nerve damage. Muscle tightness, or spasticity, can also cause pain that makes it difficult to move.
  • What kind of pain medications help with MS pain?
  • Prescription and OTC medications can help with MS pain. Prescription medications include antidepressants, antiepileptics, and muscle relaxants. OTC medications include pain relievers like NSAIDs.
  • What triggers MS pain?
  • MS pain can be triggered by damage to the central nervous system caused by MS itself, or by the changes the disease causes to your body, such as a weak leg that affects your gait and, in turn, causes hip or back pain.
  • Can you manage MS pain without medication?
  • Somewhat. MS pain can be managed to some extent by staying active, eating healthy, avoiding smoking, and maintaining a healthy weight. Alternative treatments such as acupuncture and massage may also help.

MS pain varies for everyone. You may experience dull aches due to the changes to your body caused by MS, or you could experience sharp, sudden pain caused by nerve damage. Muscle tightness, or spasticity, can also cause pain that makes it difficult to move.

Prescription and OTC medications can help with MS pain. Prescription medications include antidepressants, antiepileptics, and muscle relaxants. OTC medications include pain relievers like NSAIDs.

MS pain can be triggered by damage to the central nervous system caused by MS itself, or by the changes the disease causes to your body, such as a weak leg that affects your gait and, in turn, causes hip or back pain.

Somewhat. MS pain can be managed to some extent by staying active, eating healthy, avoiding smoking, and maintaining a healthy weight. Alternative treatments such as acupuncture and massage may also help.