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Thread: Multiple sclerosis pain undertreated

  1. #1

    Multiple sclerosis pain undertreated

    Published on 04/10/2001

    Survey: Multiple sclerosis pain undertreated

    NEW HAVEN, Conn., Apr 10 (Reuters Health) - A large-scale survey of more than 7,000 multiple sclerosis (MS) patients shows that most MS patients are undertreated and often unrecognized for pain management.

    Yale University neurologist Dr. Marco Rizzo presented these findings last week here at the 15th Yale Neuroimmunology Symposium.

    "MS patients experience migraine headaches, eye, leg, facial, bladder and skin pain. Muscular spasms and [prickling or tingling sensations of the skin] are common, and the pain is chronic," Rizzo explained.

    MS is a central nervous system disorder in which the thin protective coating called myelin that insulates nerve fibers in the brain and spine becomes damaged. Eventually, lesions develop in the brain and spinal cord that can lead to a loss of vision, weakness, numbness and tingling.

    MS occurs when white blood cells known as T cells attack the proteins that make up myelin. Currently, there is no cure for the disease.

    Chronic pain causes "miswiring," leading to abnormal pain pathways, Rizzo noted. Typical pain medications do not work in chronic pain and so MS patients need to be treated with medications such as a class of antidepressants known as tricyclic antidepressants, and anticonvulsants. Typically, more than one medication or combination needs to be given in order to effectively tackle the pain, Rizzo pointed out.

    Some of the medications Rizzo finds to be effective are gabapentin (Neurontin), lamotrigine (Lamictal), amitriptyline, the broad-spectrum anticonvulsant (divalproex) Depakote, topirimate (Topamax) and baclofen. OxyContin, a new opiate, has shown no results in managing chronic MS pain, according to Rizzo.

  2. #2

    Thanks!

    Thanks for posting this Dr. Young. Since my mother has MS (thankfully with little or no pain) I also frequent some of the MS discussion boards on the Net, and find that MANY people with MS suffer from neuropathic pain, and it is often under treated. There are still many physicians that tell their patients either that 1) MS does not cause pain, so they must not have MS, or 2) that they are simply drug seeking and so must have hysterical paralysis instead of MS.

    It is truely appauling given the emphasis that both the federal government and JCAHO are currently placing on being sure all patients with pain have appropriate interventions and a written pain management plan. (KLD)

  3. #3
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    very interesting...

    the "MS does not cause pain" thing has been used several times (once by none less than the chief of neurology at creighton university med school) to call into question my ms diagnosis. the thing that seems strange to me is that the drugs that are effective in treating ms pain are not narcotics and (at least in my experience) don't give any kind of a buzz. i have been on neurontin for quite some time, and this year had lamictal added to the mix. i can't say that i'm pain free, but it is down to a level where it is not as constantly distracting.

    there are three other people here at the nursing home i live at who also have ms. they all have pain, but their docs are not prescribing anything for it. i just don't understand why so many docs have a problem with it.

    we also can't seem to get anyone here to prescribe 4-ap. the two reasons we are given are 1)it's still in trials, and 2)it causes siezures. can't wait until acorda gets their license for it. they will probably be more open to prescribing it at that point.

  4. #4
    kathyp, Acorda is starting a clinical trial on 4-AP for MS. I know several people with MS who are on 4-AP. An informal poll in 1997 indicated that there may be as many as 10000 people in the U.S. who are taking or have taken 4-AP. Many of these have multiple sclerosis. Wise.

  5. #5
    Senior Member alan's Avatar
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    Doctors used to say that spinal cord injury can't cause pain. Fortunately, most have wised up about both SCI and MS.

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