Skeletal And Soft Tissue Pain
Pain may occur suddenly due to spasms and cramping of muscles. Sensations of throbbing, tightness and aching may occur. It may be accompanied by numbness, tingling, or head pain. You may feel as if you have a tight band around your back and chest.
You have an increased likelihood of experiencing low back and hip pain due to your disease. Spasticity and muscle weakness strain your spine and connective tissues. Pain may occur due to weakness from impaired posture. This is likely to occur if you require a cane or walker in order to get around.
Spasticity, or muscle stiffness and spasms, is due to damage MS causes in your brain and spinal cord. Messages are not transmitted properly between your nerves and the tissues in your body. Your muscles tighten and painful spasms develop.
Factors That May Make Back Pain Worse
As a person who has a chronic disabling condition, you have an increased risk of suffering from anxiety and depression. These conditions cause your muscles to become tense which worsens pain.
Many people who have MS feel isolated. You may feel like you are a burden to others at times. This can worsen feelings of depression and pain.
You may be very sensitive to changes in temperature. This is due to changes within your body which are a direct result of MS. Your back pain may be worse when the weather is hot or humid.
MS can make your skin may experience pain differently than other people. For example, fabric from a shirt or tight clothing may cause a sensation of pain.
If you are ill with an infection or are not sleeping well, your ability to tolerate pain may diminish temporarily.
Some Causes Of Ms Lower Back Pain
MS lower back pain typically presents as a musculoskeletal pain. Musculoskeletal pains are generally pains that affect the musculoskeletal system- the system of muscles and bones that makes up the framework of the human body and that is responsible for movement. Musculoskeletal pain is persistent rather than acute. It often results from muscle weakness and exhaustion, imbalance and spasticity.
All of these symptoms follow from the demyelination and inflammation of neural tissue and the consequent interruption of normal signal transmission from the nervous system to the individual muscles. The muscles, tendons and other parts of the musculoskeletal system are no longer able to function normally. Thus, they may overcompensate to make up for the abnormalities, resulting in exhaustion and pain. It may also prove so difficult for a multiple sclerosis patient to engage in any form of activity that he or she chooses to minimize movement. As a result, the muscles, ligaments and tendons may remain out of use for long. The result tends to be the weakening and atrophying of muscles. This ultimately results in pain when one tries to use them.
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You Might Like To Think About Whether The Feeling:
- comes in short or long lasting bursts or is there all the time
- started suddenly or increased bit by bit
- started at the same time as other new symptoms or when previous symptoms came back quite suddenly. This may suggest that your pain is part of a relapse.
- improves with pain killers or is relieved by changes you have made like applying heat or cold, relaxing or sitting in an upright chair
- gets worse when you do certain things.
- has happened before. When? Does it feel the same?
- is stopping you doing what youd like to do. Give some examples such as its affecting your sleep, your work or your ability to sit down for long. It is good to say exactly whats happening, for example, it takes you two hours to get to sleep or you can only sit still for 20 minutes at a time.
Multiple Sclerosis As A Cause For Hip Pain
MS is not exempt from the list of all the conditions that can generate pain in the hips.
However, the question is if pain from multiple sclerosis feels different from more common causes of pain in this joint area.
Does it have a unique sensation when compared to other causes of hip pain such as rheumatoid arthritis, a pinched nerve and a bone infection?
Hip pain related to MS does not necessarily feel different from hip pain related to other causes, says Mitzi J. Williams, MD, clinical neurologist with Morehouse School of Medicine, an MS specialist and clinical advisor for the Multiple Sclerosis Foundation.
MS does not directly affect the joints, so the pain that people experience can be related to spasticity of the muscles near the hip joint or related to the way that they walk because of weakness or imbalance from their MS, explains Dr. Williams.
Multiple sclerosis. BruceBlaus, CC BY-SA 4.0/creativecommons.org/licenses/by-sa/4.0/ Wikimedia Commons
Spasticity is a common result of multiple sclerosis, which is an autoimmune disease .
Spasticity is when the muscles are in a continuous state of contraction. This leads to stiffness and tightness which can then generate discomfort.
Essentially when they walk unevenly or have poor posture due to weakness, they compensate on the stronger side, resulting in increased stress on the hip and pain, says Dr. Williams.
Theres also always the possibility that a person with MS can have hip pain from an entirely unrelated cause.
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Problems With Thinking Learning And Planning
Some people with MS have problems with thinking, learning and planning, known as cognitive dysfunction.
This can include:
- getting stuck on words
- problems with understanding and processing visual information, such as reading a map
- difficulty with planning and problem solving people often report that they know what they want to do, but cant grasp how to do it
- problems with reasoning, such as mathematical laws or solving puzzles
But many of these problems arent specific to MS and can be caused by a wide range of other conditions, including depression and anxiety, or even some medicines.
Muscle And Mobility Problems
Another culprit for low back pain in MS is related to issues stemming from immobility. For instance, if a person with MS is using their cane or another mobility-assistive device improperly, low back pain may develop.
In order to compensate for an MS-related issue like a numb or tingling leg or foot, a person’s gait may be impaired, or they may distribute their weight unnaturally, which can put a strain on the lower back. Sitting in a wheelchair all day can also put excess pressure on one’s back.
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Treatment Options For Lower Back Pain
Most cases of lower back pain will improve with basic care but if your symptoms are persisting after a couple of weeks of self-care, it may be time to get in touch with your doctor. Some treatments will work for some but not for others, so its important to consider the following options and see what works best for you:
- Rest or modify your activities
- Take over-the-counter pain medications
- Alternate between ice and heat therapies to relax muscles and reduce swelling
- Stretch and strengthen back muscles with a series of gentle exercises as recommended by a physical therapist
- Epidural steroid injections relieve pain by reducing swelling around the compressed nerve roots
- Minimally invasive surgery to address conditions such as nerve compression or damaged discs
Spine surgery may be recommended if your if symptoms persist after trying non-surgical methods. Contact Dr. Lewis at Jackson Neurosurgery Clinic today for a comprehensive diagnosis and treatment plan to keep you feeling your best.Contact us today to learn more about lower back pain or to schedule a consultation with one of our specialists. Well find a solution that works for you! Call us at 366-1011.
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The Symptoms Of Lower Back Pain
Depending on the source of your lower back pain, symptoms can vary with pain ranging from dull to sharp. You may either feel pain in one specific spot or over a broader area that can also be accompanied by spontaneous muscle spasms. Here are some other common symptoms of lower back pain you may experience:
- Dull and persistent pain in the lower back region
- Stinging or burning sensation that radiates from the lower back to the legs
- Pain, tingling and numbness in the leg that extends below the knee
- Tightness in the lower back, hips, and pelvis
- Pain that gets worse after an extended period of time sitting or standing
- Difficulty going from a standing to sitting position
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There Are Two Main Types Of Pain In Multiple Sclerosis:
- nerve pain which is caused by damage to the nerves in the brain and spinal cord. This includes altered sensations such as pins and needles, numbness, crawling or burning feelings. Examples of nerve pain include painful sensations in the side of the face, called trigeminal neuralgia, and a tight feeling, often around the chest, called the MS hug. Pain in the limbs is very common.
- musculoskeletal pain which is caused by damage to muscles, tendons, ligaments and soft tissue, for example neck or back pain caused by changes in posture or sitting for very long periods.
Some Of The More Common Descriptions Include:
You may have a totally different description for your pain. Nerve pain is particularly difficult to describe and people with MS sometimes worry that they wont be believed or they are going mad. However, pain and unusual sensations are common in MS and treatment should be discussed with your health professionals in the same way as for any other symptom.
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Is It My Meds Or My Gait
I received Lemtrada infusions in early December. Though hip pain isnt specifically listed as a side effect in Lemtradas patient guide, the guide does list joint pain, back pain, and pain in the arms or legs as common side effects. Ive also seen posts on the unofficial Lemtrada Facebook group from patients feeling bone pain. So, could my hip pain be connected to the Lemtrada?
Or, could the pain be related to the IV steroids that are a part of the Lemtrada treatment? I had several rounds of Solu-Medrol when I was first diagnosed with MS back in the 1980s. Bone and joint pain are among the side effects listed for it. And the use of steroids may result in a loss of bone density and increase your risk of developing osteoporosis.
Another thought. Over the past three months Ive gone from using one cane to using two. Ive also increased the amount of walking Ive been doing each day . My posture is poor and my gait is unusual.
So, is my hip pain a result of my meds or my gait? Obviously, a trip to my neuro or my PCP, or both, is in the cards. Ill keep you posted on what they say.
The Brain And Spinal Cord: Where Symptoms Typically Start
Lesions in the brain may affect cognitive abilities. Some people with MS have trouble with memory, attention and concentration, multitasking and decision-making, says Dr. Scherz. The changes are usually mild at the beginning, but can be frustrating as time goes by.
MS may also cause emotional changes, such as decreased tolerance for stress and worsening anxiety and depression, either due to nerve fiber damage or simply the burden of dealing with the disease.
Vision changes are often one of the first MS symptoms. It’s common that MS starts with an attack in the optic nerve, which sends visual information from the eye to the brain, Dr. Scherz says. This happens because the optic nerve is close to the brain, and the myelin in the eye and brain is similar, she explains. People may experience blurred vision, double vision, eye pain or loss of color vision.
Difficulty articulating words or swallowing and slurred speech may occur if theres damage to the area that controls the mouth and throat. MS may lead to a loss of sensation in whatever area of the body corresponds with the damaged area of the brain or spinal cord, Dr. Scherz says. This can cause numbness or a tingling sensationfor instance, in the fingers or toes. The feeling usually comes and goes, and can be mild or severe.
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Surgical interventions to correct spinal deformity include spinal fusion, which is a surgical procedure that uses bone graft to replace a disc. After undergoing surgery, your back will require physical therapy for three to six months. In addition to doctors and dentists, you can also see neurologists, physiatrists, and chiropractors. These specialists specialize in the brain and spinal cord disorders. They are often the best choice for patients seeking treatment for back pain.
Non-specific back pain is usually not diagnosed until the pain is long-term. There is no clear cause for non-specific back pain, but doctors should seek a diagnosis to treat the condition. It is important to visit a specialist for treatment in order to get the best treatment options. If the pain is chronic or has no specific cause, a doctor will perform diagnostic imaging to help identify the exact source of the pain. Further, they can perform MRIs to help diagnose underlying conditions.
While back pain is a common ailment, it can also be caused by something else. Many people experience sciatica or other pain in the leg, and a slipped disc could be the cause. Other types of back pain may be more acute, such as a herniated disc. For nonspecific back pain, a doctor may need to perform radiological imaging to diagnose the exact cause of the pain.
When Ms Is Not The Cause
It’s important to note that a lot of people experience low back pain, regardless of whether or not they have MS. This is why it’s essential to undergo a proper diagnosis for your low back pain and not just assume it’s from your disease.
Examples of common causes of low back pain in the general population include:
- Sciatica or other lower spine nerve root compression
- Nonspecific musculoskeletal sprain/strain from trauma or injury
Much less common, but more serious causes of lower back pain include:
- Cancer that has spread to the spine
- Digestive tract problems like pancreatitis or peptic ulcer disease
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Low Back Pain Sciatica And Multiple Sclerosis
The Myth of pain and Multiple Sclerosis
Frequently Multiple Sclerosis sufferers are told that their Low Back Pain is due to their Multiple Sclerosis. Patients do suffer with fleeting episodes of pain often around joints. In the majority this arises because of the underuse of supporting muscles and loss of control of normal joint movements due to muscle atrophy.
In the lumbar spine the loss of control of the deep spinal muscles and the core stabilisers of the abdomen leads to atrophy and poorly controlled movements of the facet joints and disc. This may give rise from local pain due to abnormal micro-movements and pain from the micro-traumatised nerves. These symptoms may be managed by Muscle Balance Physiotherapy.
However chronic Low Back Pain and Sciatica arises from the same conventional pathology that affects so many of us. MS Patients are often fobbed off because they fare adversely with General Anaesthesia. Consequently many are told that their pain is arising directly from their MS. In the vast majority, this is a myth and is not the case. For patients with MS and chronic Low Back Pain and Sciatica, aware state Endoscopic Minimal Invasive Spine Surgery can effectively relieve their symptoms making the concurrent disabilities more bearable and active rehabilitation possible.
What Else Can I Do About Pain Related To Multiple Sclerosis
Regular exercise and stretching do reduce certain kinds of pain, particularly back pain and muscular pain. Such activities also help with fatigue and increase a sense of well-being. Trying to get restful sleep is also important when fighting pain. Some people find that alternative pain management strategies such as acupuncture, cognitive behavioral therapy, and psychophysiological pain and stress management techniques such as biofeedback, relaxation training and self-hypnosis are useful.
If pain is hard to control, a formal pain management program may be useful. If you are on pain medications, make sure you have a good bowel regimen as constipation is common and will only increase the discomfort you are feeling.
Last reviewed by a Cleveland Clinic medical professional on 01/28/2019.
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Drug Treatments For Nerve Pain
Not all nerve pain will be treated, for example, numbness and loss of sensation may not be treated unless they are causing particular distress.
The National Institute for Health and Care Excellence has issued guidelines for the treatment of nerve pain. As common painkillers are not effective against nerve pain, NICE recommends that people with MS should try amitriptyline, duloxetine , gabapentin or pregabalin first. Treatment usually starts with a low dose and then builds up slowly until an effective dose is reached. However, as pain is different for each person, health professionals may recommend different options depending on what may be best for you as an individual.
With any treatment, there is the possibility of side effects so these should be discussed. Many side effects wear off or can be managed effectively. For example, if a medication makes you sleepy, it may be best to take it last thing at night. This way it could act as a positive in helping you sleep if your nights rest has been disrupted by pain.
The guidelines also suggest that you and your health professional should agree a treatment plan that takes into account your concerns and expectations. Your treatment should be reviewed regularly and, if a drug is not working well enough, one of the others should be tried.
Although, nerve pain can usually be improved with drug treatments, it is often best to take other steps to managing the pain yourself .