Multiple Sclerosis can hurt! Pain Syndromes in MS


Howdy! My name is Aaron Boster, thanks for
tuning in to an impromptu educational opportunity here at OhioHealth MS
Cenrer. Today I want to speak about pain in Multiple Sclerosis. When I attended
medical school they taught me that MS doesn’t cause pain and they taught me
wrong. There’s a lot of different kinds of pain in MS and sometimes you can
trick the patient or even the doctor and the thinking is a different problem. So
we’ll talk about a couple different kinds of pain today.
The first one is OPTIC NEURITIS. Now optic neuritis is where the nerve that
runs the eyeball, it becomes inflamed and when it becomes inflamed you lose vision
but a very common symptom associated with optic neuritis is that the eye
hurts when you turn your eye looking left right up and down and. So a patient
will commonly come in and say I’m having decreased vision and it hurts my eye,
hurts sometimes they haven’t even noticed the visual loss but they notice
that their eye hurts when they move their eye around, and so that’s a form of
pain which is a bit unique to Multiple Sclerosis. The second kind of pain that I
want to talk about is called TRIGEMINAL NEURALGIA. now the trigeminal nerve is
the nerve that runs the sensation of your face and if that nerve becomes
inflamed you can have a sharp stabbing pain in your face which has been
described as some of the most severe pain that a human being can experience.
In Multiple Sclerosis if you have damage to the brain stem where the nerve comes
out of you can also have trigeminal neuralgia and this is a lancinating pain
often times people think there’s something wrong with their teeth or
there’s something wrong with their jaw and they see an oral surgeon only to
find out that it’s actually related to Multiple Sclerosis. The next kind of pain
that I want to discuss is the MS HUG. Now this is not a nice kind of hug that you
get from your mom, this is a description of being crushed or being squeezed some
people say “it feels like I have a belt wrapped around me” or “I have on really
tight undergarments” sometimes people they feel like they can’t get
get a deep breath, or they think that they have chest pain very commonly the first time
someone has an MS hug they’re getting EKGs and they’re getting tests to look
for pulmonary embolisms and at the end of the day what this is is a lesion in
this spinal cord which is sending a message of pain in a band around their
waist. This is a very aggravating kind of pain and it’s kindly seen in Multiple
Sclerosis in the setting of spinal cord damage. Another type of pain which I want
to discuss also involves the spinal cord there means now Lhermitte is the name of
a dead white European man but Lhermittes phenomenon is something that’s been
described the medical literature for quite some time and seen very commonly in MS. A patient will flex their neck and upon flexing their neck they have a zip of
electricity that runs down their back into their toes. What’s happening is they
have a spinal cord lesion and when they flex their neck they’re stretching this,
they’re stretching out the spinal cord and it’s sending, it’s called an ephaptic, a zip down their legs and it can be very very painful and sometimes
patients to avoid it will simply not move their neck, understandably so. Burning limb pain, that’s not a very
specific kind of pain. I see it all the time damage to anywhere along the
sensory pathways can result in weird abnormal ouchie feelings sometimes
patients will say that they feel like their legs on fire sometimes it feels
icy cold sometimes it just feels rough and a lot of times patients have
difficulty describing it except for, to say my leg doesn’t feel right it really
hurts and this is a very, very common thing to see in Multiple Sclerosis. Two
more times of pain that I want to discuss. Spasticity, spasticity is a
situation where the muscles are no longer cooperating. What I mean is what I
want to do this the bicep has to get shorter and the tricep has to relax in
the setting of spasticity because of damage to the brain and spinal cord when
you want to bring your arm like this the spinal cord isn’t letting go and so your
tricep is trying to do that and the result is a tug-of-war. Now if you’re
wondering why I say this, first I want you to do an experiment at home take
your hand and ball it up and a fist and hold the fist, for the next five hours
and see how it feels! Even just doing that for a few seconds, it starts to be
ouchie and hurt and if you need to move the limit can be very very painful.
Spasticity causes cramps like a charley horse which is extremely painful and so
I feel that spasticity is a type of pain that we need to consider when we’re
looking at MS. Lastly I want to talk about musculoskeletal problems and this
is a secondary kind of pain seen in MS. If you have a hitch in your giddyup and
so you have to use your your legs differently think about what’s happening
to this hip or did I need and overtime you can wear on the joints from walking
incorrectly and cause musculoskeletal pain. Again my name is Aaron Boster. Thank
you for tuning in to this impromptu educational experience. A long time ago
in med school they taught me that MS didn’t cause pain and they were wrong!

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