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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.
  Pain due to Damage

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.

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.
Muscle Use

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

Controlling Pain

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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