Multiple Sclerosis Exacerbation (Flare-Up)







OVERVIEW

Pain syndromes are common in MS. In one study, 55 percent of people with MS had “clinically significant pain” at some time; almost half (48 percent) were troubled by chronic pain. This study suggested that factors such as age at onset, length of time with MS, or degree of disability played no part in distinguishing the people with pain from the people who were pain free. The study also indicated that twice as many women as men experienced pain as part of their MS.



ACUTE PAIN

Trigeminal neuralgia is a stabbing pain in the face. It can occur as an initial symptom of MS. While it can be confused with dental pain, this pain is neuropathic (caused by damage to the trigeminal nerve) in origin. It can usually be treated with medications such as the anticonvulsants carbamazepine (Tegretol®), oxcarbazepine (Trileptal®) and lamotrigine (Lamictal®).

Lhermitte’s sign is a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward. Medications, including anticonvulsants, may be used to prevent the pain, or a soft collar may be used to limit neck flexion.

 

Burning, aching or “girdling” around the body (sometimes referred to as the “MS Hug”) are all neurologic in origin. The technical name for them is dysesthesias. These painful sensations typically affect the legs and feet, but may also affect the arms and trunk (such as the feeling of constriction around the abdomen or chest area known as the “MS Hug”). They can be very uncomfortable — even quite painful — but are not dangerous or necessarily disabling unless they are severe enough to interfere with a person’s activities. Dysesthesias are often treated with the anticonvulsant medication gabapentin (Neurontin®). Dysesthesias may also be treated with an antidepressant such as amitriptyline (Elavil®), which modifies how the central nervous system reacts to pain. Other treatments include wearing a pressure stocking or glove, which can convert the sensation of pain to one of pressure; warm compresses to the skin, which may convert the sensation of pain to one of warmth; and over-the-counter acetaminophen (Tylenol® and others) which may be taken daily, under a physician’s supervision. NationalMSSociety.org



What Are the Symptoms of Trigeminal Neuralgia?

Trigeminal neuralgia causes a sudden, severe, electric shock-like, or stabbing pain that lasts several seconds. The pain can be felt on the face and around the lips, eyes, nose, scalp, and forehead. Symptoms can be brought on when a person is brushing the teeth, putting on makeup, touching the face, swallowing, or even feeling a slight breeze.

Trigeminal neuralgia is often considered one of the most painful conditions seen in medicine. Usually, the pain is felt on one side of the jaw or cheek, but some people experience pain at different times on both sides. The attacks of pain may be repeated one after the other. They may come and go throughout the day and last for days, weeks, or months at a time. At times, the attacks can disappear for months or years. The disorder is more common in women than in men and rarely affects anyone younger than age 50. WebMD.com