Pain and MS

Pain is common in multiple sclerosis and can affect your daily life in many ways. The good news is that MS-related pain can be treated, and there are many options to help you feel better. Understanding the different types of pain can help you and your care team find the right plan for you.

MS can cause pain from damage to nerves in the brain and spinal cord (neurogenic pain). When MS damages these nerves, the nervous system can send false pain signals (so you may feel pain without an injury), or it can make simply touching something lightly feel painful. This pain can feel like burning, stabbing, tingling, or a tight squeezing sensation, and can include:

• Sharp, shock-like facial pain (trigeminal neuralgia)
• Electric-shock sensations when bending the neck (Lhermitte’s sign)
• Eye pain with vision changes (optic neuritis)
• Burning, tingling, or tight, band-like sensations (called “MS hug”)
• Spontaneous pins-and-needles sensations
• Sudden muscle tightening or spasms

Musculoskeletal Pain

MS can also cause pain that isn’t from nerve damage. Musculoskeletal pain comes from the muscles, joints, or soft tissues. In MS, it usually develops because weakness, stiffness, or balance changes make the body work harder or move differently, which can strain these areas. It can include:

• Aching muscles or joints caused by changes in posture, balance, or the way you walk
• Lower back, hip, or knee pain that develops when the body compensates for weakness or mobility changes
• Painful muscle tightness or cramping related to spasticity
• Shoulder or neck pain from overworking certain muscles or from using mobility aids

People with MS may also experience more frequent headaches, including migraines or tension-type headaches. These could be linked to stress, medication side effects, or changes in brain function caused by MS. No matter what type of pain it is, it can affect your mood, mobility and daily living. Managing pain often involves a combination of physical therapy, medication, and lifestyle changes.

Pain doesn’t just affect your body; it can also affect your mood. Pain, depression, and anxiety often go together in MS. Living with pain can make you feel sad, worried, or worn down. And feeling depressed or anxious can make pain feel stronger and harder to manage. That’s why it’s important to treat mood changes early. Getting support through medication, counseling, and other wellness practices can help lift your mood and ease pain.

Pain can be hard to describe, and it’s not always easy to explain how it affects your life. Before your next appointment, take time to prepare a brief history of your pain to help your healthcare provider better understand your experience and help share your treatment plan.

It can help to keep track of things like:

• What starts it (triggers): Does pain start after certain activities, meals, or times of day?
• What it feels like (symptoms): Write down the words that best describe it — burning, stabbing, tight, aching, or other sensations.
• How strong it is (pain level): Use a simple scale from 0 (no pain) to 10 (worst pain you can imagine).
• When and how long (patterns): Track when pain starts, how long it lasts, and what makes it better or worse.
• What medications you’re taking: Write down the names of your medicines, when you take them, and any side effects you notice.

Bringing this information to your appointment can help your healthcare team determine whether your pain is connected to MS and find the best ways to manage it. They could ask questions like:

• When do you feel the pain?
• How often does it happen?
• Where in your body do you feel it?
• What does it feel like (for example, sharp, dull, burning)?

Managing pain in MS often works best when different types of care are combined, which can include:

Medications

Different types of pain respond to different medications. There are a variety of medications available to help manage pain.  Sometimes it takes time and trying more than one medication to see what works best for you. What helps one person may not help another, so it’s important to work with your healthcare provider to find the right fit.

• Opioids are strong pain medications that might be used if nothing else has helped. They don’t work well for nerve pain and can cause problems like drowsiness, constipation, or becoming dependent. 

Rehabilitation and exercise

Staying active through regular exercise can ease stiffness, improve strength, and support balance. Stretching, walking, and strength training can help reduce pain and keep the body moving. A physiotherapist can create an exercise plan tailored exercise to you, while an occupational therapists can offer tips to make everyday tasks easier and less painful. 

Wellness practices

Mindfulness, meditation, yoga, or acupuncture can reduce stress, improve well‑being, and could make pain easier to manage.

Cannabis

Some people with MS find cannabis helps ease pain, especially when other treatments haven’t worked well. It’s not right for everyone, and research is still ongoing, but it may be worth talking to your healthcare provider to see if it could be an option for you.

Pain is often undertreated in MS, sometimes because it’s hard to describe, or because people hesitate to bring it up. Talking openly with your healthcare team and sharing details, like when the pain happens, what it feels like, and what affects it, can help them understand what you’re going through and find better ways to help.  To avoid worsening pain:

• Don’t push through severe pain
• Avoid skipping regular stretching
• Don’t suddenly stop taking prescribed medications 

If you experience any of the following, get medical care immediately: 

• Sudden severe headache
• New facial numbness or droop
• Vision loss or severe eye pain
• New electric-shock sensations or painful spasms that interfere with walking or sleep