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Unfortunately, in the past, many physicians and
neurologists have failed to understand or accept that people with MS of
all types suffer from pain. Furthermore, not only do we suffer pain,
but also the pain we feel is for a variety of reasons and causal
factors. With ongoing research and increased understanding of the disease in all
it’s forms, that perception is changing – albeit slowly in some
instances. Throughout support groups and websites, many people still
complain of unrelenting pain and doctors refusal to treat it. This is
unfortunate to say the least, because not only is the person left to
suffer pain without relief, but also to suffer the emotional pain
associated with lack of treatment. Often the person feels that their
suffering is not believed or that they are ‘imagining’ their suffering.
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Pain due to Damage
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MS causes the myelin
sheath surrounding nerve fibers to be damaged or destroyed. With
continued research, it has also now been established that MS may damage
grey matter and even the axons themselves. This damage is the most
direct way that MS can cause pain.
For example, the damage to the myelin
can result in faulty signals to be sent to the muscles – which in turn
causes painful spasms. For example, rather than the normal signal rate
resulting in firing of the action potential carrying the nerve impulse
(or directions for action) to the muscle concerned, there may be a
rapid firing or over excitation.
Over time, the muscles may be
stretched, or strained in much the same way as an athlete’s muscles are
after a workout, thus causing additional and longer lasting pain.
Additionally, signals coming from various parts of the body to the
brain may not be sufficient to result in the required action. For
example, when a person wishes to pick up an object, it requires a
certain amount of ‘force’ applied to the object in order to maintain
grasp. If the "signal" is insufficient, the person may think that they
are holding the object securely, but when he/she tries to pick it up,
the object falls. This is because the signals for grasp strength was
faulty – just as the signal "yes I am holding it tightly enough" was
faulty. The result is that the object is dropped, and the person is
surprised!
Furthermore, due to the damage, the
pain fibers, which connect to the pain receptors in the brain, may send
faulty signals; the brain interprets these impulses as ‘pain’. Often
neurologists and physicians believe that the pain suffered by an
individual is due to these ‘false’ signals and will not prescribe pain
relief. In addition, to nerve signals which relay ‘commands’ for
movement to the muscles, there are also nerves which relay information
to and from the skin and various other tissues of the body. For
example, when we are cold or sometimes afraid, the skin will contract
causing little bumps, hairs may stand on end etc.
There are also nerve fibers, which
carry information about the environment back to the brain for
interpretation, such as, the sense of temperature and texture. These
may also be effected by damage and therefore, the perception of cold
may be interpreted as "hot", sharp sensation may not be felt at all or
may be interpreted as blunt. There are also fibers, which conduct
information to calm perception as well. If these are damaged, then pain
once perceived does not remit as the calming influence from the brain
and spinal cord is not received. For example, most people have
experienced the situation of diving into a cold pool. After a while the
feeling of "frigid" and the intense shock passes and after a while the
temperature of the water does not feel so bad after all. This is
because once the ‘alarm’ has been raised – brrr cold – the brain will
send a signal to lessen the sensation of pain in the skin. If these
areas are damaged, then the signal is either not sent – or not sent
with sufficient quality to reduce the perception of pain.
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Hypersensitivity
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Furthermore, due to the
absence of calming pain, receptors may become hypersensitive and almost
every sensation to the skin or body may be interpreted as painful
stimuli. For example, a light touch may be perceived as an equivalent
to a slap or the weight of clothes or firmness of belts or shoes may be
interpreted as unbearable pressure. These sorts of pains described
above may respond well to Baclofen, Zanaflex for spasms Neurontin and
Tegretol – sometimes even over the counter medications such as Tylenol
helps.
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Muscle Use
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Muscles
may also ache due to normal use. When the muscles are not receiving the
proper signals, or they are not used much they become weakened;
therefore, even the smallest amount of effort to do a menial task can
result in much pain.
This like so many of the
other MS symptoms, becomes worse during fatigue, heat, over exertion or
other illness. One of the most difficult tasks for us is to determine
our ‘limits’ of activity – even the smallest task can leave us with
chronic muscle fatigue and soreness the next day.
The spine may also
become mis-aligned due to the atrophy of muscles. This is most commonly
observed in people who have one side, which is weaker than the other
is. This condition may lead to a change in posture sufficient that it
causes pain through pressure on the spine, hips, neck and shoulders
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Controlling Pain
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There
are many non-pharmaceutical means for controlling or limiting the
amount of excess pain we suffer. Such as either passive or active
exercise to reduce, atrophy, controlling levels of fatigue, and
understanding the limits of our capacity.
In addition, by employing physical therapeutic interventions, we may need to learn new or safer ways to accomplish tasks.
Taking little rests within
activity can help recover some of the muscle fatigue and therefore
lessen the amount of aches and pains suffered next day. Rest certainly
can improve function.
As discussed in the cycle of
stress and pain, reducing stress and good stress management techniques
can also control pain levels.
Knowing our limits is difficult
to do and even more difficult to admit, but pain can be exacerbated by
pushing beyond what our muscles and bodies are capable of doing.
However, regardless of the causal factors contributing to pain – when
in pain all things become even more difficult and we cannot afford to
push through pain anymore.
Finally, although we all have
progressive MS, we are also human and therefore are prone to developing
other illnesses and conditions, which may either produce pain or make
existing pain worse. Therefore, it is essential to have new or
worsening pain investigated and treated.
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