Pain, a physiological warm function

Why do we feel pain? Pain occurs when tissue is overloaded or injured. It is therefore a physiological warning function of the body. This warning function is intended to make you avoid pain-inducing events or avoid these pain stimuli. For example, if you put your hand on a hot hob, you feel a strong burning sensation that makes you intuitively pull your hand away again. This is an example of how pain can arise.

Pain can be caused by various stimuli to the pain receptors. On the one hand, as in our burn example, through thermal stimuli such as heat and cold. On the other hand, through mechanical stimuli such as pressure, injuries, bruises or burns, or through chemical stimuli such as inflammation, acids or toxins. In addition to the various causes of pain, there are also different types of pain:

Basically, pain can be divided into physiological & neuropathic pain.

• Physiological (nociceptive) pain is triggered by irritation of the nerve endings, for example through skin injuries, broken bones or heat.
• Neuropathic pain, on the other hand, is caused by injuries or malfunctions of the nervous system. This can be trigeminal pain or phantom pain, for example.

Pain can also be divided into several categories. These categories include duration (acute vs. chronic), pain quality (sharp, dull, pulsating, burning), localization (headache, groin pain, joint pain, muscle pain) and the organ systems affected (muscle and skeletal pain, visceral pain).

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Types of pain in multiple sclerosis

Neuropathic pain plays a major role in multiple sclerosis. Neuropathic pain is pain caused by damage to or malfunction of the nervous system. In multiple sclerosis, the transmission of nerve signals is disrupted and can therefore also cause pain. A distinction is made between three types of neuropathic pain: Trigeminal neuralgia, dysesthetic pain and Lhermitte's sign.‍

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Trigeminal neuralgia

The trigeminal nerve is the fifth of twelve large cranial nerves and supplies large sensitive areas of the head that are responsible for feeling. Damage to this nerve leads to neuropathic pain. Even the smallest sensations in the face, such as those triggered by a draught of air or chewing food, can lead to violent, sudden attacks of pain. Often only one side of the face is affected and sufferers feel this pain in the upper and lower jaw, lips or cheeks.

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Dysaesthetic pain

Dysesthetic pain is described as constant, burning pain that occurs without external stimuli. Dysesthetic pain usually occurs at night in the legs and feet, and physical activity can exacerbate this pain.‍

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Lhermitte's sign

This type of pain occurs when the head is bent slightly or strongly forward. Those affected feel electrifying sensations from the neck to the extremities. This pain is caused by the stretching of the pain-sensitive meninges due to the bending of the spine.

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Other types of pain

In addition to neuropathic pain, nociceptive pain, i.e. physiological pain, can also occur in multiple sclerosis. MS patients are particularly affected by headaches, muscular pain (e.g. back, neck, extremities) or pain caused by spasms and cramps.

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Pain therapies for multiple sclerosis

To counteract the chronification of pain, it is advisable to treat it.As a basis for therapy, it can be helpful for your healthcare professional if you can describe pain symptoms precisely.‍‍

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Pain therapy with medication

Different types of pain require different pain medication. The first choice for neuropathic pain is anti-convulsants such as gabapentin or pregabalin. Nociceptive pain is treated according to the WHO step-by-step scheme. This step-by-step scheme was developed by the World Health Organization (WHO) for drug-based pain therapy.‍A patient is usually treated first as shown in stage 1. Stage 1 consists of non-opioid therapy. If this pain therapy is not successful, opioids can be used from the second stage onwards.Non-opioids are, for example, drugs such as ibuprofen, paracetamol or diclofenac. Tramadol or tilidine are low-potency opioids, whereas morphine, oxycodone or fentanyl are high-potency, i.e. very strong opioids. Co-analgesics are, for example, antidepressants or anticonvulsants. Aduvants are drugs that are used to treat nausea or constipation.

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Alternative pain therapy

However, pain cannot only be treated with medication. There are numerous non-drug approaches, such as physiotherapy, occupational therapy, massages or heat treatments, which can provide relief.  Mental health care is also important and can also help with physical pain. Meditation, mindfulness exercises or psychotherapy, for example, are used here. In traditional Chinese medicine (TCM), acupuncture is also used to treat pain. Regular physical activity and regular fitness or endurance sports should not be forgotten, not only for physical health but also for mental health.