Pain in multiple sclerosis
Amanda Howarth, clinical nurse specialist - pain management,
Pain Clinic & MS Clinic, Royal Hallamshire Hospital, Sheffield
Way Ahead 2000;4(1):3
Pain is a symptom experienced by people with MS that until recently has been neglected (Kaissirer and Osterberg 1987, Paty and Ebers 1998). Up until the 1980's there is little mention in the literature of the problem and indeed in some papers it has been reported as a painless disease. This appears not to be the case as pain is reported in an estimated 13%-80% of the MS population (Archibald et al 1994). The variability in the percentage of people being reported as experiencing pain may be due to methodological problems in the studies related to patient self-reporting, the exclusion of certain types of pains from some of the studies and unreliable data collection methods such as charts being reviewed retrospectively and prospectively.
Pain is frequently listed as one of the initial symptoms of the disease or as a paroxysmal symptom during its course (Matthews 1998). Pain experienced can be either as a result of the disease from demyelination of the nerves or due to disability being experienced e.g. low back pain related to abnormal posture, spasm of the spinal musculature or osteoporosis linked to immobility and treatment with corticosteroids. Whatever the cause, pain is most definitely a problem experienced by people with MS.
The majority of pain experienced by people with MS is chronic in nature and therefore searching for a cure is not always the most appropriate course of action. The approach needed requires a focus towards management of the symptom by reducing the level of pain and helping the sufferer to cope more effectively with the pain and the impact it is having on their lives.
Pain experienced by anyone is a complex multidimensional phenomenon affected by physical, psychological, social and spiritual factors. When assessing chronic pain problems, these aspects need to be taken into account. Pain cannot be effectively assessed and addressed as a purely physical problem. A comprehensive pain assessment needs to include the following:
·
location of the pain
location of the pain ·duration of the pain
duration of the pain ·frequency of the pain
frequency of the pain ·intensity of the pain
intensity of the pain ·type of pain
type of pain ·disability caused by the pain
disability caused by the pain ·what causes an increase in the pain
what causes an increase in the pain ·what causes a decrease in the pain
what causes a decrease in the pain ·effects of the pain
effects of the pain ·effects of the treatment
effects of the treatment ·psychosocial factors
psychosocial factors ·established patterns of coping
established patterns of coping Where possible this assessment should be carried out by someone experienced in chronic pain management. If this is not possible then referral on to a multidisciplinary pain management clinic should be considered.
Treatments available for the management of pain vary considerably but can include some of the following:
·Medication: use of anticonvulsants and antidepressants for neurogenic pain alongside regular analgesics.
Medication: use of anticonvulsants and antidepressants for neurogenic pain alongside regular analgesics. ·TENS can be used for both musculo-skeletal and neurogenic pain.
TENS can be used for both musculo-skeletal and neurogenic pain. ·Relaxation: pain is often accompanied by tension and muscle stiffness that can make the experience of pain worse. Relaxation training can help people to recognise this and reduce levels of tension thus directly affecting the experience of pain.
Relaxation: pain is often accompanied by tension and muscle stiffness that can make the experience of pain worse. Relaxation training can help people to recognise this and reduce levels of tension thus directly affecting the experience of pain. ·Sleep management: people with pain often experience sleep problems including an inability to get off to sleep and being woken during the night by the pain. Attention to routine and discussion on what to do if people cannot sleep can improve sleep patterns and subsequently enable people to cope better with their pain problem.
Sleep management: people with pain often experience sleep problems including an inability to get off to sleep and being woken during the night by the pain. Attention to routine and discussion on what to do if people cannot sleep can improve sleep patterns and subsequently enable people to cope better with their pain problem. ·Invasive procedures such as trigger point injections, facet joint injections, epidurals, and nerve blocks are usually carried out by anaesthetists in pain clinics and are used for specific pain problems. They do not get rid of chronic pain problems but can help to reduce levels of pain and thus improve a persons ability to manage whilst hopefully improving their mobility.
Invasive procedures such as trigger point injections, facet joint injections, epidurals, and nerve blocks are usually carried out by anaesthetists in pain clinics and are used for specific pain problems. They do not get rid of chronic pain problems but can help to reduce levels of pain and thus improve a persons ability to manage whilst hopefully improving their mobility. ·Acupuncture can be used for more localised pain problems. Either trigger point acupuncture or traditional Chinese acupuncture can be used to reduced levels of pain, and again improve levels of coping.
Acupuncture can be used for more localised pain problems. Either trigger point acupuncture or traditional Chinese acupuncture can be used to reduced levels of pain, and again improve levels of coping. ·Aromatherapy massage is beneficial for widespread diffuse pain. It can reduce muscle stiffness and promotes relaxation and wellbeing. Treatments undertaken in a hospital setting can be continued at home with people using essential oils in baths, locally applied lotions and through simple massage techniques that can be taught to relatives and carers.
Aromatherapy massage is beneficial for widespread diffuse pain. It can reduce muscle stiffness and promotes relaxation and wellbeing. Treatments undertaken in a hospital setting can be continued at home with people using essential oils in baths, locally applied lotions and through simple massage techniques that can be taught to relatives and carers. ·Reflexology has the potential to relieve painful symptoms and improve relaxation and well-being.
Reflexology has the potential to relieve painful symptoms and improve relaxation and well-being. Pain in multiple sclerosis is a distressing symptom that requires attention. Thorough assessment and an individually tailored package of management strategies can reduce levels of pain and increase people's ability to cope. This will subsequently improve quality of life.
References
Archibald CJ, McGrath PJ, Ritvo PG, Fisk JD, Bhan V, Maxner CE, Murray TJ . Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain 1994; 58(1): 89-93.
clinic sample of multiple sclerosis patients. Pain 1994; 58(1): 89-93. Kassirer MR, Osterberg DH. Pain in multiple sclerosis. Am J Nurs 1987;87(7):968-969.
Matthews B. Differential diagnosis of multiple sclerosis and related disorders. In: Compston DAS, Matthews WB, MacDonald WI, Ebers G, Weckerle H, Lassman H. McAlpine's multiple sclerosis. 3rd edition. Edinburgh: Churchill Livingstone; 1998. pp 145-190.
Livingstone; 1998. pp 145-190. Paty DW, Ebers GC. Multiple sclerosis. Philadelphia: F.A. Davis Company; 1998.
Amanda Howarth, clinical nurse specialist - pain management,
Pain Clinic & MS Clinic, Royal Hallamshire Hospital, Sheffield
Way Ahead 2000;4(1):3
| ||||
The national discussion forum and community for UK Healthcare Professionals with an interest in acute, chronic, or palliative Pain Management.
.co.uk
.com
www.
This page was last updated: December 23, 2005
