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Multiple Sclerosis. Need to know

Updated: May 17, 2021


Definitions/Diagnostic criteria


Epidemiology (MS Guide Sheet)

Pain is a common symptom in MS

Incidence of pain within one-month is between 53-79%

Point prevalence is about 50% (not including headache)

Chronic pain in 65%


Risk factors (for pain in MS)

Higher pain levels in females

Higher age

Number of years since disease onset

Moderate-Severe mobility and disability restriction

Multiple sites of involvement



Central nerve pain is thought to be the predominant pain mechanism in MS

It is propagated by two mechanisms:

- Generation of ectopic impulses at demyelinated lesions in response to neural damage

- Interruption of inhibitory impulses from the brain

Nociceptive pain (particularly in lower back, neck, and head) can occur from irregular, asymmetric movement patterns and postures and changes in muscle strength, tone (spasticity), or length (contracture)

It can also be from spasticity and muscle spasm causing aching, cramping, pulling or stiffness. These are often worse at night or early in the morning.

Pain from fractures can be a feature and osteoporosis needs to be considered

Headache can be caused by cervical demyelinating plaques, posture, cervicogenic changes, or even from medications

Pain can be further broken down into these subgroups:

  1. Continuous central neuropathic pain (e.g. dysaesthetic extremity pain)

  2. Intermittent central neuropathic pain (e.g. Trigeminal neuralgia)

  3. Musculoskeletal pain (e.g. Painful tonic spasms, muscle spasms)

  4. Mixed neuropathic and non-neuropathic pain (E.g. Headache)


Presentation (for those with pain in MS)

Often significantly effects activities of daily living

40% have difficulty working, 44% have difficulty sleeping, and 34% have troubled relationships

Increased risk for comorbid anxiety, depression, and lower mental health scores

Lhermitte's sign and painful tonic spasms are thought to be due to the demyelination process

Pressure area pains can occur

Painful tonic spasms




Differential diagnosis








Golden pearls





References / Articles / Resources

  1. MS Practice - Health Practioner guide sheet

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