Home > MS Community > Ask the Doctor

Other than Neurontin, what can I take for nerve pain? Would Estrogen therapy help?

Question Date: 8/28/2012

Answer: Although multiple sclerosis was previously thought of as a “painless” disease, it is now recognized that pain is a common symptom in MS, affecting over 50% of patients at some point in their disease. Unfortunately, pain is a rather generic term that can refer to numerous underlying issues; in addition, people have different “tolerances,” above which stimuli are deemed as painful. Certainly, the factors for the later are an area of intense research. Pain may refer to a local destructive process (i.e. skin breakdown from sacral decubitus ulcer, fracture, or trauma) or may represent a disruption in the mechanism for sensory input, including altered sensory signals (dysthesias) or the sensation that normal stimuli are painful (allodynia). An individual’s experience of pain is likely altered by co-existing conditions and previous experiences with pain (or health care response to pain). Obviously, not all painful sensations in an MS patient are a direct result of multiple sclerosis; therefore, the first step in pain management is to appropriately delineate the nature / etiology of the specific pain (or pains) in question. As with most MS symptoms, treatment of pain in MS is accomplished best by utilizing a team approach including pharmacological and non-pharmacological modalities. Many people suffer from musculoskeletal pain, often due to abnormal “wear and tear” of muscles or joints. Often, this is described as an aching pain, usually precipitated (or exacerbated) by certain movements, and often responsive to non-steroidal anti-inflammatory medications (like ibuprofen), heat, ice, and rest. Physical therapy is often helpful with this type of pain, providing exercises to strengthen muscle and increase flexibility, to normalize function and improve posture. Therapists also use other modalities, including ultrasound or electric stimulation, to relieve pain. Musculoskeletal pain is quite common in patient with multiple sclerosis and may be due to alterations in function due to acquired neurological deficits. For example, one patient with a foot drop due to leg weakness may develop hip or back pain from “hiking the hip upwards” to clear the foot when walking; others may get pain in the good leg because of “overuse” in an attempt to compensate for the affected limb. Patients with LE weakness from spastic paraparesis may hyperextend their knee (genu recurvatum), which can lead to abnormal wear and tear (and pain in the affected joint); on the other hand, if the weakness is severe, a joint may develop a decreased range of motion or even freeze (develop a contracture) due to decreased movement. Spasticity is a very common finding in patients with multiple sclerosis. Although often described as “muscle stiffness,” it is defined as “velocity-dependant resistance to muscle stretch”. Although spasticity is sometimes painful (causing muscle stiffness and spasms), it can often be beneficial, allowing patients to compensate for underlying weakness, in that a spastic leg is often stiffly extended, and a spastic arm is often in flexion. Obviously, too much tone can not only be painful, but it can also interfere with function and increase fatigue (due to the excessive muscle contraction). Unfortunately, other types of pain (or infection) can exacerbate spasticity, at times leading to a “vicious cycle” of increased pain and increased spasticity. Treatment of spasticity is also multi-disciplinary, often involving physical therapy (active and passive stretch) and medications like baclofen (Lioresil) and tizanidine (Zanaflex). • It is thought that this nerve pain is caused by an aberrant signal jumping from one damaged nerve to another (so-called ephaptic transmission), which is likely why this type of pain often responds to seizure medications (anti-convulsants), which probably reduce the aforementioned “short circuits.” Gabapentin (Neurontin) or pregabalin (Lyrica) is often used to treat this type of pain; other epilepsy medications like lamotrigine (Lamictal) or carbamazepine (Tegretol) can also be used. Tricyclic antidepressants like amitriptyline (Elavil) and nortriptyline (Pamelor) can also be effective. Depression is very common in patients with MS (much more so than in the general population), and often “depression hurts,” especially in patients who have significant other issues with pain. I suspect that there is a vicious cycle with pain and depression with worsening pain leading to worsening depression, and vice versa, and I have had patients experience improvement with both mood and pain with agents like duloxetine (Cymbalta) and venlafaxine (Effexor). The topic of hormones in MS deserves an article by itself. Given that women are over 3 times more likely to get MS than men suggests that female hormones play a role in MS; it has also been observed that pregnancy is a relatively protective time from an MS point of view, but the disease is often quite active in the post-partum period. These observations have lead to some ongoing clinical trials in MS. Certainly, the Women’s Health Initiative raised significant questions about the safety of hormone replacement, and there is very little data to support hormones for pain relief.

Answer Date: 8/28/2012


Dr. David Jones


  Calendar of Events
Find out when the MSF will be in your community. Participate, sponsor, or get active now!
get involved now

  Support the MSF
Supporting MSF's programs to help make "a brighter tomorrow" has never been easier.
make a donation 

Unless otherwise specified, all medical content is compiled by MSF staff and reviewed for accuracy by a member of our Medical Advisory Board.

The MSF strives to present clear and unbiased information. This site is partially funded through a grant from Bayer Healthcare, LLC.

Website Design by SimplexWeb

© Copyright 2000-2013 Multiple Sclerosis Foundation - All Rights Reserved

リモワ リモワ アウトレット リモワ アウトレットモール リモワ アウトレット店舗 リモワ アウトレット 本物 リモワ アウトレット ドイツ リモワ アウトレット店 リモワ アウトレット 楽天 リモワ クラシックフライト リモワ クラシックフライト tsa リモワ クラシックフライト 63l リモワ クラシックフライト 35l リモワ クラシックフライト 2輪 リモワ クラシックフライト 激安 リモワ クラシックフライト 黒 リモワ クラシックフライト トパーズ リモワ クラシックフライト アタッシュケース リモワクラシックフライト 機内持ち込み リモワ クラシック rimowa クラシックフライト リモワクラシックフライト ユナイテッドアローズ リモワ フライト リモワ サルサ リモワ サルサエアー リモワ サルサデラックス リモワ サルサ ユナイテッドアローズ リモワ サルサ 86l リモワ サルサ 35l リモワ サルサ 激安 リモワ サルサエアー 34l リモワ サルサ 赤 リモワサルサ スーツケース リモワサルサ レッド リモワのサルサ リモワ サルサエアー 94l リモワ サルサエアー 63l リモワ サルサエアー 35l リモワ サルサエアー 84 リモワ サルサエアー ホワイト リモワ サルサエアー 20l リモワ サルサエアー 持ち手 リモワ サルサ エアー 激安 リモワサルサエアー ルビー リモワ サルサ エアー ネイビー リモワサルサエアー レンタル リモワ スーツケース リモワ スーツケース レンタル リモワ スーツケース サルサ リモワ スーツケース 機内持ち込み リモワ スーツケース 販売店 リモワ スーツケース 白 リモワ スーツケース 店舗 リモワ スーツケース カバー リモワスーツケース 激安 リモワスーツケース アウトレット rimowa スーツケース リモワ トパーズ リモワ トパーズ ステルス リモワ トパーズ チタニウム リモワ トパーズ 82l リモワ トパーズ 32l リモワ トパーズ プレミアム リモワ トパーズ 63l リモワ トパーズ 64l リモワ トパーズ 最安値 リモワ トパーズ 激安 リモワ トパーズ 35l リモワ トパーズ ゴールド リモワ トパーズ スーツケース リモワ リモワ 機内持ち込み リモワ リンボ リモワ ビジネストローリー リモワ スーツケース リモワ アウトレット リモワ 激安 リモワスーツケース rimowa rimowa激安 リモワ 通販 リモワ スーツケース 通販 リモワ リモワ サルサ リモワ トパーズ リモワ 機内持ち込み リモワ クラシックフライト リモワ サルサデラックス リモワ サルサエアー リモワ リンボ リモワ ビジネストローリー リモワ サルサ 激安 リモワ スーツケース リモワ リモワ アウトレット リモワスーツケース アウトレット リモワ 激安 リモワスーツケース リモワ サルサ rimowa rimowa激安 リモワ リモワ サルサ リモワ スーツケース リモワ 激安 リモワ サルサエアー リモワ アウトレット リモワ クラシックフライト リモワ 通販 リモワ スーツケース 通販