For many people who have multiple sclerosis (MS), living with the condition often means experiencing a certain amount of pain. This pain can take many forms, some of them short-lived.

In many cases, though, MS-related pain is chronic and will never disappear entirely. But that doesn’t mean it can’t be treated and effectively managed. Here are some of the different types of chronic pain caused by multiple sclerosis, along with treatments that may help reduce your symptoms.

Causes of Chronic Pain in MS

There are three main causes of pain in MS, according to Léorah Freeman, MD, neurologist and assistant professor at the McGovern Medical School at the University of Texas Health Science Center in Houston. These include neuropathic pain, pain related to spasticity, and musculoskeletal pain due to immobility and fatigue.

Neuropathic pain, says Dr. Freeman, “is caused by damage to the nerve fibers from the inflammatory process. And that may cause burning, tingling, and painful pins-and-needles sensations.”

Sometimes, people even perceive a light touch as painful in certain areas of the body, according to Freeman.

“Some people describe a sunburned feeling. It can be different in different people,” says Anne Cross, MD, professor of neurology and head of the neuroimmunology section at Washington University School of Medicine in St. Louis. “It can sometimes feel deep; it can sometimes feel on the surface.”

Spasticity is a common type of stiffness in people with MS that’s caused by damage to motor nerve fibers. Freeman says, “It can cause muscle spasms, cramps, and an overall achiness and tightness in the body parts that are affected. And the spasms can be very painful and debilitating for people with MS.”

Finally, immobility and fatigue can cause people with MS to compensate by using other muscles in ways that cause pain. This process commonly causes back or joint pain, says Freeman, even if your underlying mobility issues mainly affect another area of the body.

Drug Treatments for Chronic MS Pain

Neuropathic pain is commonly treated with drugs that were originally developed as anticonvulsants (for seizures) or antidepressants, but given at lower doses, according to Freeman. “These medications,” she says, “modify the way the nervous system reacts to the pain on a biological level.”

Dr. Cross notes that these drugs include the anticonvulsants Neurontin (gabapentin), Tegretol (carbamazepine), and Dilantin (phenytoin), as well as the tricyclic antidepressant amitriptyline.

For spasticity, the drugs baclofen and Zanaflex (tizanidine) can greatly reduce painful cramping and other symptoms. Cross also occasionally prescribes benzodiazepines, like Valium (diazepam), but prefers not to because of the risk of habituation, which is when the brain develops a tolerance to the actions of the drug and eventually needs a higher dose to obtain the same effects.

In more severe cases of spasticity, says Freeman, more invasive procedures, like injections of Botox (onabotulinumtoxinA) or the placement of a baclofen pump, can directly treat the affected area of the body. Both treatments, she says, can be “truly life-changing” in their pain reduction.

For musculoskeletal pain related to immobility, Cross tends to start out with mild nonsteroidal anti-inflammatory drugs (NSAIDs), like Aleve (naproxen) and Advil or Motrin (ibuprofen). If these drugs aren’t effective enough, sometimes she’ll try using Flexeril (cyclobenzaprine), a muscle relaxer.

“I try my best to avoid any use of narcotics,” says Cross, due to the risk of addiction. Freeman takes the same approach, noting that opioids can also cause constipation and drowsiness.

Exercise and Physical Therapy for MS Pain

Neuropathic pain, says Cross, doesn’t tend to respond much to exercise or physical therapy. But these approaches can work well in many people with spasticity or musculoskeletal pain.

“Usually I try to do those in combination with medical therapy,” says Cross.

Both Cross and Freeman stress the importance of stretching for people with spasticity. “I find it is essential to encourage people with MS to stretch daily — in particular the muscles that are most effected by the cramps,” says Freeman.

Freeman also encourages people with spasticity or musculoskeletal pain to exercise for at least two hours each week, “from light walking to more active forms of exercise” like circuit training, in which you move from station to station to complete a sequence of exercises, with no rest time between the exercises.

Physical therapy can be especially helpful for musculoskeletal pain, says Cross. “You can sometimes build up the opposing muscles with certain physical therapy maneuvers,” she says, which helps to eliminate the root cause of the pain.

Freeman says that many of her patients benefit from stretching in the context of yoga classes — “light, restorative yoga,” rather than more intense variations of the practice. She recommends looking into offerings at a local gym or YMCA, or seeing if the National Multiple Sclerosis Society offers any classes in your area.

Home and Alternative Remedies

For neuropathic pain, Freeman recommends trying warm compresses or heated pads, used on a daily basis. Some people also benefit from pressure socks or gloves. These devices can “trick the brain to make sense of the pain as warmth or pressure instead,” she says.

In addition to stretching, good nutrition may help prevent cramps, says Freeman. This means staying hydrated and eating foods rich in potassium and magnesium — like bananas and leafy greens — since “an imbalance of these minerals can result in painful cramps.”

Some people with spasticity or musculoskeletal pain find massage therapy helpful. In fact, a study published in December 2016 in the International Journal of Therapeutic Massage & Bodywork found that in a small group of people with MS, massage therapy once a week for six weeks led to a reduction in self-reported fatigue, pain, and spasticity.

Cross notes that some of her patients have tried acupuncture, “particularly for pain that’s hard to control, like neuropathic pain. And some of them feel it’s been helpful.”

Another promising approach, says Freeman, is mindfulness or meditation. By focusing your brain on something other than your pain, she says, you may actually reduce pain signals in your brain.

It’s also important, Freeman says, to be on the lookout for fatigue and depression, both of which can worsen pain perception. “It is very, very important to discuss these issues, and to treat them appropriately,” she says, both medically and also “with more holistic lifestyle modifications.”