Pain due to multiple sclerosis

Pain due to multiple sclerosis (MS) can affect different parts of the body and has various causes. The conditions that are most common and difficult to treat are:

• trigeminal neuralgia, due to a lesion of the trigeminal tract in the pons
• neuropathic pain in the lower limbs or thorax, due to spinal cord lesions.

Trigeminal neuralgia presents, and is treated, as for other causes of the condition (see advice), except that microvascular decompression is not appropriate therapy.

Neuropathic pain in MS can be due to spinal cord lesions or other causes. It is treated as for other causes of neuropathic pain (see advice).

Pain on eye movement, with impaired vision or changes in colour vision, is usually due to optic neuritis. For acute changes, refer immediately for expert advice, as the patient may have had an acute relapse and need a corticosteroid.

Pain in MS can also be due to other complications (eg spasticity, contractures)—diagnose and treat appropriately. Tonic spasms are rare in MS, common in neuromyelitis optica, and often painful (see paroxysmal symptoms).