Clinic speak: pain in MS

Pain and sleep problems in MSers explained. #MSBlog #Clinicspeak

“The following YouTube video from the National MS Society is worth watching. If you have any queries on issues raised please do not hesitate to ask.”

Other posts on pain:

14 Aug 2013
METHODS:Self-report survey data was collected for a sample of 1877 individuals with spinal cord injury, neuromuscular disease, postpolio syndrome, or multiple sclerosis. Rates of pain severity and pain interference in these 
07 Aug 2013
“Neuropathic pain is another form of pain and is typically due to damage of central sensory pathways. When these sensory nerves recover they insert a different type of sodium channel into their membranes to restore electrical 
07 Jun 2013
Background: Neuropathic pain is a frequent chronic presentation in autoimmune diseases of the nervous system, such as multiple sclerosis (MS) and Guillain-Barre syndrome (GBS), causing significant individual disablement 
01 Jun 2013
Purpose/Objective: To define the rates of pain, depression, and their co-occurrence in persons with multiple sclerosis (MS). Research Method/Design: Participants were 161 persons with MS who previously participated in 
11 May 2013
The aim of this work is to examine the course and impact of chronic pain and pain-related disability in persons with multiple sclerosis (pwMS) over a 7-year period in the Australian community employing a longitudinal, 
18 Jan 2013
Methods: We systematically identified prospective studies detailing pain prevalence in definite MS. We used pooled prevalence estimates, explored heterogeneity using meta-regression, and analysed prevalence during the 
27 Jan 2013
OBJECTIVE: This is a report of a case of central pain successfully treated by epidural placement of spinal cord stimulator electrodes. Neuromodulation of primary afferent fibers and the underlying dorsal root entry zone 
18 Dec 2012
Patterns of pain-free response in 497 cases of classic trigeminal neuralgia treated with Gamma Knife surgery and followed up for least 1 year. J Neurosurg. 2012 Dec;117 Suppl:181-8. doi: 10.3171/2012.8.GKS121015.
06 Jul 2012
Pharmacological treatment of pain in MS is challenging due to the many underlying mechanisms. Few controlled trials show adequate pain control in this population. Emerging evidence suggests that pain might be more 
31 Jul 2012
In this clinical and neurophysiological study, we examined the clinical characteristics and underlying mechanisms of neuropathic pain related to multiple sclerosis. A total of 302 consecutive patients with multiple sclerosis 
08 Aug 2012
Central neuropathic pain in MSers is a common debilitating symptom, which is mostly treated with tricyclic antidepressants or antiepileptics (e.g. gabapentin, carbamazepine, oxcarbamazepine). Unfortunately, the use of these 
03 Dec 2012
A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis 
20 Feb 2012
Levetiracetam is an anti-convulsant which is assumed to act by modulating neurotransmitter release via binding to the vesicle protein SV2A. This could have an impact on signalling in the pain pathway. The aim of this study 
21 May 2012
METHODS: Retrospective review of patients having balloon micro-compression (BMC) (n=69) or glycerol rhizotomy (PRGR) (n=67) from 1997-2010. Patients in the two groups were similar with regard to age, gender, pain 
14 Aug 2013
The pain sensitive structures in the brain that cause headache or the blood vessels (arteries, veins and venous sinuses), meninges (membranous coverings of the brain), cranial nerves, paranasal air sinuses, skull and scalp.
06 Sep 2011
Pain in patients with multiple sclerosis: a complex assessment including quantitative and qualitative measurements provides for a disease-related biopsychosocial pain model. J Pain Res. 2011;4:219-25. Epub 2011 Aug 2.
28 Jul 2012
Outcomes from direct comparisons between different procedures for MS-related TN is lacking. In this study, initial pain-free rates (IPFR), duration of pain-free intervals (PFI) and associated prognostic factors were evaluated.
06 Mar 2012
Hopefully a new treatment for spasticity and pain in MS. Fast Forward and Concert Pharmaceuticals Announce Collaboration to Advance Novel Treatment for Spasticity and Pain in Multiple Sclerosis. Press release March 5, 

Other posts on sleep:

28 May 2013
Proportion of MSers with symptoms suggestive of sleep apnea – a potentially serious disorder which causes you to stop breathing repeatedly, often hundreds of times in the night during your sleep = 71%. Proportion of MSers 
05 Apr 2013
BACKGROUND: The objectives of this cross-sectional study were to assess the prevalence and severity of sleep apnea in MSers referred for overnight polysomnography (PSG) and to explore the radiographic and clinical 
06 May 2013
“Recently I have focused on sleep problems in MS. One particular problem is bladder overactivity at night that results in you having to get up several times to pass urine. There is a treatment for this. The drug is called DDAVP 
15 Apr 2013
“Last Thursday I made a clinical diagnosis of obstructive sleep apnoea in a MSers attending my clinic. I have now referred this individual for a sleep study. If I am correct treatment for this condition could relieve his daytime 
25 Nov 2012
BACKGROUND: Poor sleep is a frequent symptom in patients with multiple sclerosis (MS). Sleep may be influenced by MS-related symptoms and adverse effects from immunotherapy and symptomatic medications. We aimed 
20 Jan 2012
METHODS: Ambulatory MS’ers without a known sleep disorder completed the Short Form (36) Health Survey (SF-36), pain visual analog scale, and two consecutive overnight PSGs. HRQoL was assessed using SF-36 
28 May 2012
Methods: Demographic and clinical characteristics of unselected consecutive MSers were collected. Different questionnaires were used to assess quality of sleep, daytime sleepiness, fatigue, anxiety, depression and quality of 
26 Aug 2012
MSers with sleep disorders were offered standard treatment. 56 subjects repeated the questionnaires after ≥ three months, and were assigned to one of three groups: sleep disorders that were treated (SD-Tx, n=21), sleep 
31 Dec 2011
Objective: We evaluated the relationship of obstructive sleep apnea to fatigue and sleepiness in MS patients.Methods: Ambulatory MS patients without known sleep disorders and healthy controls underwent diagnostic 
13 Jun 2012
Pain and anxiety are the most common symptoms that affect sleep in MSers. Both of these symptoms are treatable therefore we are letting you down. Please bring this to the attention of your neurologists or specialist nurse.
06 Aug 2011
“Apologies, all the terms used in this post may be foreign to you. This above list is simply a list of all the types of sleep disorders MS’ers may suffer from; some are very rare, whilst other are very common. If you are interested in 
10 Dec 2011
BACKGROUND: Sleep disruption and fatigue are common in Multiple Sclerosis (MS). Melatonin is one of the major regulators of sleep-wake cycle. The role of melatonin in MS-related sleep disturbances and fatigue as well as 
17 Aug 2012
BACKGROUND:The objectives of this cross-sectional study were to assess the prevalence and severity of sleep apnea in patients with multiple sclerosis (MS)referred for overnight polysomnography (PSG) and to explore the 
06 Aug 2011
How do you know if you have a sleep disorder? I suggest you take the following online survey; it should take you less than 2 minutes to complete. Online Sleep Disorders Screening Survey. Or. Complete the following 
20 Jan 2011
Fatigue is very common in MS and can be attributed to many factors. This paper reviews sleep disturbances in MS and it association with fatigue. In people with significant fatigue sleep hygiene should be on top of the 
09 Apr 2013
Other features of narcolepsy include rapid onset of a phase of sleep called REM, or rapid eye movement, sleep, cataplexy which is sudden loss of muscle tone with emotion and sleep paralysis; waking-up with the inability to 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Interesting that one Dr. in the video stated she would not prescribe smoking cannabis for pain due to the side effects ( i.e. high tar content). In a previous post the negative effect of smoking on neutralizing antibodies to DMTs was mentioned. Now that medical marijuana is legal in some countries/states it seems that this is a mixed message.

  • This is the problem….no sensible medical approach should suggest that smoking is the way forward for delivery of medicine. The medical fraterity has battled for years to limit the effects of smoking of tobacco, why create another problem.

By Prof G



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