b'offers the best way of managing spasticity.Amitriptyline (Elavil), nortriptyline (Pamelor), Whentreatingspasticity,Iliketogettheduloxetine (Cymbalta), venlafaxine (Effexor), physical therapists involved early. Ironically,and desvenlafaxine (Pristiq) are some of the not all spasticity is a bad thing. Some peoplepossible options. Typically, any of these with MS benet from an increase in extensormedications would be started at a low dose toneinthelegs,asitmayhelpovercomeand slowly titrated up until the pain has weaknessandaidintransfers.Similarly,improved, side effects are seen, or the when thinking about an intrathecal baclofenmaximum safe dose is achieved.pump, a team approach is best.A curious phenomenon with pain in MS NeeuurrooppaatthhiiccppaaiinnN is that it is frequently worse at night. We see Central neuropathic pain is another cause forthis with both spasms and with central discomfort directly related to MS. Neuropathicneuropathic pain. This may mean that sleep is pain may be burning in nature or causedisrupted and daytime fatigue is magnied. hypersensitivity to touch. Some people havePain that occurs primarily at night also presents tingling, buzzing, or crawly sensations thata possible treatment advantage in that, we become painful. These symptoms are due todont have to worry as much about sedation disruptions in the normal sensory pathways inas a drug side-effect if the medication is only the spinal cord or brain from demyelination.beingusedatbedtime.Aswithspasms, While these symptoms can be quite like thosecannabis may be a treatment option for central caused by a peripheral neuropathy, the locationneuropathic pain.of the sensory disruption is different betweenNNeeuurraallggiiaassthe two. Peripheral neuropathies, such as thoseNeuralgias represent a unique cause of seen in some people with diabetes, are becausepainforsomelivingwithMS.Trigeminal of damage in the peripheral nerves outsideneuralgia (Tic Douloureux) is pain that travels ofthecentralnervoussystem.Again,thealong the trigeminal nerve or cranial nerve 5 symptoms and even the treatment can beinto the face. This nerve has three branchessimilarbetweencentralneuropathicpainV1, V2, and V3 - supplying sensation to the and a peripheral neuropathy. forehead,cheekandjawrespectively. Neuropathic pain may be managed withTrigeminal neuralgia typically affects V2 or V3.medications. Most of our therapy options fallThe pain can be intense and debilitating. broadly into one of two classes: anticonvulsantIt is described aslightning bolts of shock-like drugs or antidepressant drugs. Anticonvulsantpain shooting into the face. It can be worsened drugs frequently work by decreasing abnormalwith talking, chewing, light touch, or even the electrical cross talk between nerve bers. Thiswind blowing across the face. It may come in makes them potentially useful for managingepisodes lasting days, weeks, or months. It may neuropathic pain. Options include gabapentinremit, only to return in the future. Trigeminal (Neurontin), pregabalin (Lyrica), carbamazepineneuralgia can occur in people without an MS (Tegretol), and oxcarbazepine (Trileptal).diagnosis as well.Neuropathic pain may also be attacked through the modulation of neurotransmittersCarbamazepine and oxcarbazepine have like serotonin and norepinephrine. This isbeen our standby therapies and can be quite where antidepressant medications may help.effective. More refractory cases may need to be 11 msfocusmagazine.org'