PAIN

I have mentioned previously on the “management of MS complications” section that, pain is not all caused by MS. There are two types of pain:

1. Neuropathic pain: MS related pain as an example.
2. Nociceptive pain: Joint and bone pains are an example. 

I am not going to repeat that here, but instead, I will try my best to help MS sufferers understand their aches and pains, and learn how to cope.

One important point I would like to stress on here from my own experience managing MS pains for more than 17 years; I would like to mention – and want my dear MS patients and this website readers to be aware – that not every pain is organic in nature, and not every pain just needs pain medications to control it. This may sound a bit strange or odd for those none-medical people, but it is true and it is real. 

Let me mention something from our own life, something we all experience or already have experienced. When any one of us go for a lovely and enjoyable holiday, most of our aches, pains, stresses, and tiredness just vanish, disappear, or we don’t feel their effect on us. We only feel them again when we are on board of the air plain, ferry, train, or in our own cars heading back home leaving our chosen holiday destination behind us!. Please think back about those very days during and following your holidays.

Please share with me the understanding that “not every pain is a real pain”, even though I do very strongly understand and appreciate the degree of suffering and inconvenience MS sufferers experience. I am not at all belittling your suffering, nor trying to say that “it is all in your mind !”, I just wanted to make you aware and see life a bit wider than you or I think.

Your neurologist or general practitioner is the one to  assess your aches and pains on the first instance and to tell you about them. Your doctor is the one who will seriously try to control your aches and pains and reduce your suffering to make you comfortable and enjoy your life or do your daily requirements. 

Some pains are easy to diagnose and treat, and some (fewer) can be a challenging job for even the best of doctors. Pain clinics usually are the best places for everyone with “difficult to control” pains to visit and seek help. Many pain clinics however do deal with nociceptive pains, and treat every pain as nociceptive unless it was clear from previous investigations. Medications for nociceptive pains are not necessarily helpful in neuropathic pains, because the mechanisms are different, and the chemicals involved are not the same.  

Paracetamol, codeine preparations, non-steroidal anti-inflammatory medications such as ibuprofen, diclofenac(voltarol), naproxen, etc, as well as buprenorphine, tramadol, and morphine preparations are basically nociceptive pain medications, and generally are not the best choice for neuropathic pains including tingling, burning, sharp pains(toothache like), and band like tightening pains(MS hugs !). Tramadol and Morphine may dull the neuropathic pain, but they are not the best choice for that type of pains. 

I would like to mention here that every pain is not controlled by high doses of morphine is not necessarily organic pain, and other aspects must be looked at such as anxiety, depression, stresses, lack of sleep(insomnia), and frustrations. Sometimes, treating those conditions on their own controls the aches and pains other drugs failed to control. Combinations of treatments do sometimes help. Psychotherapy can sometimes prove to be dramatic in pain control. 

Another point I would like to mention here for both patients and doctors that abuse of analgesia(pain medications) can on itself cause pains and headaches far more than expected or thought about.

One lady of my patients I would like to mention here as a good example on how many pain killers can be more harmful than helpful. She was in her early sixties, and for 14 years she had uncontrolled migraine headache despite of herself was under care of a senior neurologist. When I saw her referred to me by her general practitioner as she was not happy with her ongoing migraine, I found out among other things from listening to that nice lady and her helpful husband that she was on 4 medications for her migraine !!. After assessment, discussions, knowing more about her and her personality, getting more familiar with her and her husband, gaining a lot of confidence from both of them; I decided to reduce her medications gradually to just 20 mgs of Amitriptyline  per night eventually. I was myself amazed by how much that lady has improved and how much lively she became. She was then discharged from my clinic, and I remember she wrote to me saying: Thank you for giving me my life back again !!. That was a real nice outcome, and her phrase was very much appreciated and deeply felt as it was clearly emerged from her deep feelings.

How can you help to control your aches & pains in MS?

Please always remember that pain control is not a doctor’s job alone. It has to be an integrated work between you, your spouse/children, and your doctor. Pain is not a chest or urinary bladder infections those can easily be controlled by antibiotics. Pain control is unfortunately a “trials & errors” approach, because every patient is different, and your biology is not necessarily similar to the other person’s biology. 

Good communication between you and your doctor is the best way to control your aches and pains. One additional note I thought to mention… nerve pain medications are generally useless in controlling numbness. Numbness is a “negative” sign in comparison with tingling and burning sensations which are “positive” signs. Nerve pain medications are very good in controlling positive symptoms, but are not helpful in controlling negative symptoms. 

Let me now give you some advises to help you control your aches and pains, and enjoy a relaxed happy life:

1. See your doctor for any disturbing sensory symptoms of any nature.
2. Watch your sleeping at night, and your life style including your relationships with your surroundings(home, work, and social places).
3. Try relaxing programmes such as yoga, meditations, soft music from your own choices, and changing your life style including food and drinks.
4. Try to engage yourself with interesting things, and if you have got no hobbies, just create one. Many things you can think about and help you to divert your attention.
5. Review your social life, and search for real good friends who you can trust and confide to, to share your concerns without worry or fear.
6. Always remember the alternatives for controlling aches and pains such as swimming, massage, aromatic oils, acupuncture, TENS machines, and capsaicin creams or ointments on local areas of pain and burning.
7. Restless leg syndrome can be a source of “silent” discomfort and it can be hard to diagnose. Restless leg syndrome is a known complication of MS, and can very easily be treated if the right remedy is used.

Finally, I would like to remind you about the “pain threshold”. Your pain threshold is your internal ability to tolerate pain. Pain threshold is different from one person to another, and in the same person, it can be different from one time to another. If you are very happy and ecstatic, your pain threshold is at its biggest value, and your pain tolerance is at its best. Pain threshold can be so narrow(you are very sensitive to everything including ordinary noises) when you are at your tether: bored, restless, not having enough sleep, angry with yourself, anxious, worried, stressful, apprehensive, or badly disappointed. It can get narrower with some medications such as stimulants and creation drugs. It can get narrow with some amount of alcohol sometimes, though alcohol in general increases the pain threshold and improves your pain tolerance.

Your pain threshold can get wider and bigger when you are on a happy vacation including lovely and enjoyable holiday especially if it is with someone you like that much !. It can get bigger when you play enjoyable sports, when your are on an easy competition, when you go happily to social events such as weddings, birthday parties, or annual happy occasions. It can get significantly larger and bigger when you listen to your favourite music especially if there was a pleasant nostalgia linked to your choices of music. !.

I wish you all the best, and please be happy and feel happy inside yourselves. Always remember that after every bad time, comes the good time…. So, please be optimistic and futuristic. Please leave the past to history books and museums, and think about now and tomorrow.