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Andrea Williams, with her black Labrador retriever, Bertie, uses a variety of treatments to relieve her pain. But, as is the case for many people with MS, they don’t totally eliminate her discomfort. Photo by Nick Berard
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Pain, pain go away

Yes, we CAM
Dr. Maloni and others believe the answer to chronic pain may be through a “biopsychosocial approach” that encompasses not only the body, but also the mind and spirit, she says in her report. Complementary and alternative medical (CAM) approaches to pain management encompass non-drug therapies such as electrical stimulation and acupuncture, natural substances such as dietary supplements and cannabis, psychological interventions such as meditation and stress management, and lifestyle modifications such as diet adjustments and behavioral therapy.

A woman receiving transcutaneous electrical nerve stimulation on her back.

Transcutaneous electrical nerve stimulation offers pain relief with low-voltage electrical current.

Electrical stimulation devices. Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) block pain transmission and sensory neuron interpretation from the spinal cord to the brain, Rohrig says. A review of four studies, published in May in Multiple Sclerosis and Related Disorders, found that TENS therapy safely reduces chronic pain in people with MS.

TENS and IFC therapy can be self-administered via a battery-powered machine about the size of a cellphone. The machine powers two electrodes that are placed on the skin near the painful area. Rohrig says a physical therapist can show you how and when to use the machine, and can suggest devices that are eligible for insurance coverage.

Radial shockwave therapy. Physical therapists or other healthcare professionals apply a wand that emits high-energy sound waves to painful parts of your body. These sound waves (scientifically known as shockwaves) are thought to reduce the muscle hypertonia (tightness) that contributes to spasticity-related pain. One study, published in Multiple Sclerosis in April, found that radial shockwave therapy reduced ankle pain in people with MS.

Acupuncture. There is quite a bit of evidence that this ancient Chinese healing modality can alleviate pain. Acupuncture involves placing fine needles along meridians, or channels, in the body to unblock vital energy, also known as chi or qi. Acupuncturists say blocked energy can contribute to pain, along with a variety of other mental and physical conditions.

The evidence is limited on acupuncture and MS pain, however. A June 2014 review of MS-related acupuncture studies, published in Evidence-Based Complementary and Alternative Medicine, found only two studies having to do with pain. One study involved only one woman. In the other study, researchers found that biweekly acupuncture treatments for six months significantly improved pain-related disability. However, the researchers didn’t report whether the participants used pain meds in addition to acupuncture.

Acupuncture generally needs to be ongoing to successfully treat pain, making it too costly for some people with MS. “I’ve never tried it because it’s not covered by my health insurance,” says Williams. Some insurers do pay for acupuncture treatments, though, so check with your provider.

Vitamin B12. All of the B vitamins have been shown in a variety of studies to improve neural health, but Dr. Ko says B12, in particular, is known as the nerve vitamin. He suggests asking your doctor to check your B12 levels to make sure you’re not deficient.

Cannabis. Clinical trials show promising results for medical marijuana’s ability to manage pain. However, it’s still illegal federally and in many states. That’s why Dr. Ko prefers synthetic cannabinoids, such as the FDA-approved Marinol or nabilone (Cesamet). “I’ve been prescribing cannabinoids for 20-plus years, and I’ve found that not only do they help relieve pain, but they’re less addictive than opiates like oxycontin,” he says.

The American Academy of Neurology released evidence-based guidelines in 2014 that rated complementary and alternative treatments for MS symptoms as either level A, B or C. Oral cannabis extract scored a level A for spasticity and non-neuropathic pain. However, with regard to cannabis plant material, Dr. Rae-Grant points out that the data’s “not great” in terms of how specific strains affect MS pain. Consequently, “it’s our last line of defense,” he says.

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Meditation and hypnosis. “You can’t just tell yourself not to think about pain,” Dr. Ko says. “You need instruction in how to do that.” A 2011 study showed that people with MS who practiced self-hypnosis either with or without cognitive behavioral therapy had statistically significant decreases in pain. A variety of classes and books teach these techniques.

Exercise. For some people, exercise can lessen pain. But for others, it can make it worse. Rohrig recommends checking with your doctor or physical therapist before beginning an exercise program.

Nutrition. A diet that’s high in sugar and simple carbohydrates like white bread and pasta can increase inflammation—which can increase pain, says Dr. Ko. Supplementing with omega-3 fatty acids may help with pain and nerve function, he adds.

462_365_iStock_000008218973_Med_fmtSleep. Dr. Rae-Grant says this is a Catch-22: Pain can prevent sleep, and lack of sleep can contribute to widespread pain throughout your body. If you’re having trouble sleeping, Dr. Ko suggests a sleep study to address conditions such as sleep apnea and restless leg syndrome, often seen in people with MS.

Stress management. Dr. Ko recommends meditation techniques as well as talk therapy—whether it’s with a group of other people with MS pain, with your family and friends, or with a professional counselor.

Because MS pain can be as individual as the symptoms, Dr. Ko and others say it’s important to be open to trying a variety of therapies, often at the same time. That message certainly resonates with Williams.

“I’m bound and determined not to give up,” she says.

“I know there’s pain relief out there somewhere.”

Vicky Uhland is a freelance writer and editor in Lafayette, Colorado.
Winter 2015-16
Visit MSconnection.org to talk to others about how they manage MS-related pain.
You’re not alone. Pain is one of the most common symptoms in multiple sclerosis. Recent studies are investigating why and how pain occurs as part of MS.
Read more about managing pain and MS from the National MS Society’s resources.
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