Pain

     Among the symptoms associated with MS, pain is one of the most common – affecting nearly two-thirds of patients – and can impact nearly every part of the body 1. MS pain is often a result of nerve damage and muscle spasms2, as in myofascial pain syndrome (MPS). Pain in areas of the body unaffected by nerve damage can result from overcompensating for limitations of the stiff or spastic limbs. There are plenty of over-the-counter and prescribed conventional medications that one can use, but may have undesirable side effects. Fortunately, natural remedies exist that can help lessen pain.

  • Hot compresses, especially those enhanced by soothing herbs such as turmeric, ginger, and camphor, have been used in Far Eastern health practices against pain for hundreds of years in conjunction with traditional massage or as a stand-alone therapy. A review of 13 studies involving a total of nearly 800 patients found the benefits of hot herbal compresses to be similar to those of nonsteroidal anti-inflammatory drugs and knee exercise in osteoarthritis 3.

  • Massage therapy promotes relaxation of muscles and increases signals that are soothing to the nervous system and may be supportive of pain relief. Preoperative massage treatments have been shown to reduce pain, anxiety, and tension in patients undergoing cardiac surgery 2. Where the tension of tight muscles can directly cause pain, massage is thought to promote relaxation of muscle and connective tissue fibers that in turn enables deactivation of pain receptors 4. The pressure of therapeutic touch also provides a short-lived analgesic effect through the activation of “mechanoreceptors” just beneath the skin, which in turn block signals from local pain receptors 5,6. Additionally, massage has been shown to trigger greater release of natural opiates such as β-endorphins, which mediate profound pain suppression 7. Various types of massage therapies are described in a dedicated section of this website.

  • Physical therapy has been shown to improve triggers of limb pain in MS, including through reduction in spasticity. Additionally, when combined with reflexology, guided muscle stretching was associated with melioration of pain indicators in MS 8.

  • Herbs traditionally used to combat “neuropathic” pain (caused by nerve disorders) include the following9,10:

    • Acorus calamus (sweet flag)

    • Artemisia dracunculus (tarragon)

    • Butea monosperma (flame of the forest or sacred tree)

    • Capsicum spp. (chili peppers)

    • Citrullus colocynthis (Abu Jahl’s melon, colocynth, bitter apple, bitter cucumber, egusi, vine of Sodom, or wild gourd)

    • Curcuma longa (turmeric)

    • Crocus sativus (saffron)

    • Elaeagnus angustifolia (Russian olive, silver berry, oleaster, or wild olive)

    • Ginkgo biloba

    • Mitragyna speciosa (kratom)

    • Momordica charantia (bitter melon)

    • Nigella sativa (black cumin)

    • Ocimum sanctum (holy basil)

    • Phyllanthus amarus (Indian gooseberry)

    • Pterodon pubescens Benth (sucupira)

    • Rubia cordifolia (madder)

    • Salvia officinalis (sage)

  • Cannabis is a plant native to central and south Asia used for centuries both medicinally and recreationally, the latter due to its psychoactive effects. The species Cannabis sativa has been researched in MS for decades for apparent benefits against related muscle spasticity 11,12, pain, and other discomforts13. An analysis of anecdotal evidence of THC and CBD against MS-related pain showed the treatment to hold promise 14. The relationship with pain was supported by randomized, placebo-controlled clinical studies 13,15.


References

1. Drulovic J, Basic-Kes V, Grgic S, et al. The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey. Pain Med. Aug 2015;16(8):1597-602. doi:10.1111/pme.12731

2. Schroeder B, Doig J, Premkumar K. The effects of massage therapy on multiple sclerosis patients’ quality of life and leg function. Evid Based Complement Alternat Med. 2014;2014:640916. doi:10.1155/2014/640916

3. Dhippayom T, Kongkaew C, Chaiyakunapruk N, et al. Clinical effects of thai herbal compress: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:942378. doi:10.1155/2015/942378

4. Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35(3):235-56. doi:10.2165/00007256-200535030-00004

5. Watson J. PAIN MECHANISMS – A REVIEW: I. Characteristics of the peripheral receptors. Aust J Physiother. Oct 1981;27(5):135-43. doi:10.1016/S0004-9514(14)60753-4

6. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. Nov 19 1965;150(3699):971-9. doi:10.1126/science.150.3699.971

7. Goats GC. Massage–the scientific basis of an ancient art: Part 2. Physiological and therapeutic effects. Br J Sports Med. Sep 1994;28(3):153-6. doi:10.1136/bjsm.28.3.153

8. Vypasnya I, Mytskan, B., Popel, S., Mytskan, T., Ivanyshyn, I., Banakh, V., Levandovska, L., Gryb, V. non-medicinal Correction of motor Disorders of the Valley of the foot in multiple sclerosis. Acta Balneological. 2021;163(1):26-325-14.

9. Forouzanfar F, Hosseinzadeh H. Medicinal herbs in the treatment of neuropathic pain: a review. Iran J Basic Med Sci. Apr 2018;21(4):347-358. doi:10.22038/IJBMS.2018.24026.6021

10. Peppin JF, Pappagallo M. Capsaicinoids in the treatment of neuropathic pain: a review. Ther Adv Neurol Disord. Jan 2014;7(1):22-32. doi:10.1177/1756285613501576

11. Petro DJ, Ellenberger C, Jr. Treatment of human spasticity with delta 9-tetrahydrocannabinol. J Clin Pharmacol. Aug-Sep 1981;21(S1):413S-416S. doi:10.1002/j.1552-4604.1981.tb02621.x

12. Ungerleider JT, Andyrsiak T, Fairbanks L, Ellison GW, Myers LW. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Adv Alcohol Subst Abuse. 1987;7(1):39-50. doi:10.1300/j251v07n01_04

13. Wade DT, Makela P, Robson P, House H, Bateman C. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler. Aug 2004;10(4):434-41. doi:10.1191/1352458504ms1082oa

14. Notcutt W, Price M, Miller R, et al. Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 ‘N of 1’ studies. Anaesthesia. May 2004;59(5):440-52. doi:10.1111/j.1365-2044.2004.03674.x

15. Rog DJ, Nurmikko TJ, Friede T, Young CA. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology. Sep 27 2005;65(6):812-9. doi:10.1212/01.wnl.0000176753.45410.8b

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