How Can I Manage Chronic Pain with MS? A Q&A with Dr. Kratz

Neurological damage caused by MS can lead to specific pain symptoms, including:

• The "MS hug," or a painful constricting feeling around the torso
• Lhermitte's sign, or an electrical feeling down the back of the neck
• Trigeminal neuralgia, or facial pain

People who have MS can also experience other kinds of pain, like musculoskeletal pain or comorbid pain conditions, like fibromyalgia. And yet, pain is often an unrecognized or misdiagnosed symptom of MS.

We caught up with pain expert Anna Kratz, Ph.D., an associate professor at the University of Michigan who conducted MS research for more than 15 years. Here, she shares insight on what to know about pain in MS, current treatment options, and what people living with the condition can do to manage pain on their own.

Why may pain be misunderstood or misdiagnosed in people who have MS?

Anna Kratz, Ph.D.: There's definitely a misconception that MS is not a condition that's associated with pain. I've heard that from people who have MS, but I've also heard it from doctors, including pain specialists.

Then, when people do talk about pain in MS, they often default to just focusing on neuropathic pain, and they don’t recognize that people with MS might be dealing with multiple kinds of pain. You might have pain from a sports injury or poor body mechanics, and you might have fibromyalgia pain, along with MS-related neuropathic pain. But many clinicians just focus on the MS-specific pain.

Why is addressing pain so important?

A.K.: There’s been a lot of research on what some people call the unseen symptoms of MS and how they overlap—symptoms like fatigue, pain, depressed mood, and cognitive functioning. And not surprisingly, people who have pain also tend to have more depression, more cognitive problems.

One of the things that we're trying to understand is how these symptoms are not just clustered but also how they might be related. For example, is fatigue related to pain? It seems like that's the case—having pain is exhausting.

But we've also seen data that shows that when you have increases in fatigue, it’s followed by an increase in pain. So, it's also true that fatigue is painful. We know that these symptoms—alone and together—have a big impact on quality of life.

What are some options for treating and managing pain?

A.K.: It's really important to have some understanding of what's causing your pain, because the treatment approach should be matched to its cause. That said, a ton of options are available.

Many medications are available for neuropathic pain specifically, such as certain types of antidepressants. Over-the-counter medications like Tylenol (acetaminophen) and Motrin (i​​buprofen) are especially useful for musculoskeletal pain.

Opioids are in the news as medication that people need to be careful with, and there's very little evidence that they should be used for chronic pain long term.

In addition to medication, physical therapy is a common treatment that can be helpful for managing a range of MS symptoms, including pain.

There’s also psychotherapy. Most people don’t think of seeing a psychologist for pain, but there is a whole subspecialty of pain psychology to help people self-manage and cope with chronic pain.

When should someone see their doctor about pain?

A.K.: When you’re dealing with chronic pain over time, you learn to live with it in the background. But if chronic pain is messing with your ability to function—physically, emotionally, socially, or professionally—it’s time to go see a doctor or a clinician about it.

You should especially have any new pain checked out, because sometimes new or different pain can be a real indicator that there's something wrong. Unfortunately, people living with MS can develop other health issues, as well. So don't blow it off, especially if the pain is getting worse.

Can lifestyle changes help people manage pain, as well?

A.K.: There are a lot of self-management strategies people with MS can use. We know that healthy living can be really impactful on pain. And so, the first line of advice is to:

• Eat well
• Exercise to the extent that you can
• Get enough sleep

There are also complementary therapies, like acupuncture, that some limited research suggests may help people cope with pain.

Another big topic of conversation now in MS is cannabis, and there are many studies underway. As of now, the jury's still out on whether or not it can help. But there's a lot of interest in alternative medication, because the reality is that the medications that are available for pain are pretty limited.

That said, there's no one silver bullet. Most people find a combination of medication, therapy, and lifestyle changes that work for them. If you ask somebody who's managing their pain pretty well, they can probably give you a list of everything they do, from how they prioritize sleep, to their medication, to things that they avoid in their diet, to doing things like taking hot showers and warm baths—or a cool shower or cool bath. Or sometimes people just need to take breaks throughout the day to lie down.

Over time, that list of what helps you manage pain will change, because pain changes. So, I think the people who are coping well are the people who are adjusting as best they can to their pain, and they're being flexible with their approach on how to best manage it.

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