One of the first pieces of advice given with an early Multiple Sclerosis diagnosis is to stay active. But the MS relief is often impeded by unbearable pain. How can you stay active, or increase your activity if the pain is unbearable? Conventional pain management will sometimes help, but with Multiple Sclerosis relief is more often found with a combination of pharmacologic approaches.  It is estimated that about 55% of MS patients have pain classified as clinically significant due to their MS.  About half (48%) suffered general chronic pain.  But each patients pain is unique and must be categorized first then it must be determined if the pain is caused from something other than the MS.  Relief can be found with a combination of drugs, if drugs are needed at all.


Four broad categories of pain are associated with MS. Relief is tailored to the cause


  • Neuropathic pain is either chronic or recurring and is the result of the demyelination process causing abnormal functioning of the brain and spinal cord.  The anticonvulsant drugs in the class of Neurontin and Tegretol are usually part of treatment for this type of pain.
  • Acute pain is a result of the inflammation process of an active attack
  • Pain secondary to increased muscle tone is associated most often with spasticity
  • Non-specific Chronic pain in the neck or back may be a result of muscle weakness.  Myofascial pain due to disuse can cause constant pain in any region or pain that subsides and returns regularly.  Opioid analgesics usually are part of the management of this type of pain


Some combination of drugs is usually found to be effective in dealing with each separate category of pain associated with Multiple Sclerosis.  Relief is seldom found with one drug alone when a pharmacologic approach is determined to be the best way to deal with the pain.  It must be realized that when you are suffering with debilitating pain, nothing else really matters, and no alternatives or lifestyle changes will be considered to alter the course of the MS.  Relief of pain is paramount.  After it is under control, only then will most patients start to explore avenues of disease modification.


What medications are effective in MS relief of pain?


Most commonly, these drugs considered are anticonvusants, antidepressants, Cymbalta (a selective serotonin norepinephrine reuptake inhibitor) and anti-anxiety medications like valium or Klonopin.

Conventional Pain Management centers would usually not even consider anti-depressant drugs in combination with a drug like Neurontin, but physicians specializing in MS pain management know that these combinations are what are needed.  The most common pain complaint in MS patients is trigeminal neuralgia, nerve root distribution and pain in the extremities.  Anticonvulsants are more effective with this type of pain caused by MS.  Relief is often most effective when combined with anti-depressants because of their effect on the seratonergic neurotransmitter system.  Even opiate drugs work differently in MS patients than the general population seeking pan management.  They act as neurotransmitters at receptor sites in the spinal cord and the brain stem.

So pain management is different for patients with Multiple Sclerosis.  Relief comes from an understanding of the disease and the way pharmaceuticals react with the Central Nervous system.

If you decide to seek pain management using prescription medications, be sure to see a physician specializing in MS.  Other pain management regimens commonly used may never work and result in years wasted on ineffective treatments, as well as dealing with side effects and even addictions to narcotics that aren’t necessary.