Burning And Stabbing Sensations
Perhaps the most agonizing symptom I have is the burning and stabbing sensations. I am thankful not everyone with MS gets these, because it really does feel like a punishment being handed down for some terrible thing Ive done in my past. Primarily affecting my legs most of the time, it feels like I am burning from the inside out. Some days its a mild burn or even just achiness, but many other times its an intense searing pain. I feel like Im being burned at the stake at times. It can last from minutes to even a full day. Its just awful, theres no word that truly can explain how awful it is. Ive had my share of pains in my life. Ive suffered numerous broken bones , several bad cuts , torn a hamstring, absorbed some vicious hits in football and hockey, a couple of concussions, torn my meniscus, chipped a bone in my knee, a bad bout of meningitis, a severe burn that resulted in hospital time, and have had some pretty bad falls from MS . I like to think I have a good pain tolerance, but nothing has really compared to this burning sensation I get now. Its a level of pain I never imagined existed and I now deal with it on a daily basis.
When Ms Is Not The Cause
It’s important to note that a lot of people experience low back pain, regardless of whether or not they have MS. This is why it’s essential to undergo a proper diagnosis for your low back pain and not just assume it’s from your disease.
Examples of common causes of low back pain in the general population include:
- Sciatica or other lower spine nerve root compression
- Nonspecific musculoskeletal sprain/strain from trauma or injury
Much less common, but more serious causes of lower back pain include:
- Cancer that has spread to the spine
- Cauda equina syndrome
- Compression fracture in the vertebrae : MS patients may be at particular risk for this due to use of corticosteroids.
Finally, sometimes a person thinks their pain stems from their lower back when it’s actually referred pain, meaning the source of the pain is not in the muscles and ligaments of the back.
Examples of sources of referred pain include:
- Pelvic conditions like pelvic inflammatory disease
Medicines To The Rescue
A doctor might also prescribe medicine to help with the muscle spasms. Some of them might include a variety of muscle relaxant, like baclofen or Zanaflex.
He might prescribe a central nervous system depressant like Valium, or other benzodiazepines.
This is to slow down the central nervous system activity, which will decrease muscle spasms and the pain.
Sometimes a doctor might suggest you should have a pump implant. This pump would continually deliver an appropriate amount of medicine, which would reduce your symptoms.
Sometimes a doctor might decide to inject a substance known as Botox in your muscles, to help them relax.
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Pain In Multiple Sclerosis
Pain is a common symptom that affects up to two-thirds of people with multiple sclerosis , according to the Multiple Sclerosis International Federation . Pain in MS can be paroxysmal or may become chronic. When pain becomes insidious, it can impact quality of life and ones mood.
Most common types of pain in MS include:
Neuropathic pain, including pins and needles, burning, itching, stabbing, numbness, tingling, aching, throbbing, heightened sensitivity to touch, abnormal sensations, girdling , or headache
Musculoskeletal pain, related to muscular weakness or fatigue, spasticity, stiffness, joint pain, back pain, or poor posture
Paroxysmal pains, such as trigeminal neuralgia or tonic spasms
LHermittes sign, described as an electric-shock-like sensation traveling down the spine and into the limbs when the neck is bent toward the chest
Optic neuritis, a common first symptom of MS, causing pain felt behind the eye that is made worse with eye movement
How Is Pain Treated
How your pain is treated will depend on the cause and severity of the pain. This means that you need a thorough assessment to decide whether the pain is nerve pain, muscle pain or might be due to causes other than MS. Assessment may be carried out by a neurologist, MS nurse, physiotherapist, or occupational therapist, amongst others, depending on the type of pain and the likely choice of treatment. You may be referred to a pain clinic to see the specialist pain team.
Treating pain often means trying several treatments one after the other, or perhaps at the same time, to see what works best for you. You have a role to play, not only in following the advice of your health professionals about treatments, but in making changes to your daily life to minimise your pain and its effects on you. Your health professionals should review your treatment regularly and suggest alternatives if something is not working well.
It may not be possible to get rid of your pain completely so it may be a case of managing it as well as possible to reduce its impact on everyday life.
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Preoperative Planning Once A Decision Has Been Made For Tka
Milder fluctuating or more severe paroxysmal MS symptoms may occur independent of MS relapses and should be optimally managed before surgery, especially spasticity. In their report of 2 cases with refractory postoperative spasticity, Shannon et al. proposed that a preoperative increase in oral antispasticity medication might reduce the risk for severe postoperative spasticity. Although this may be a reasonable approach for selected patients, intolerable side effects often do not allow sufficient dose titration to control the spasticity. This was the case with our patient. Poor patient satisfaction with available antispasticity pharmacological options is common in MS .
Because spasticity may be worsened under any stressors, screening and treating stressors may have a marked impact on the spasticity. Some treatable common stressors include urinary tract infection , urinary retention, constipation, uncontrolled pain, and severe anxiety. The usual symptoms of UTI may not be readily apparent in persons with MS. Prophylactic treatment for UTI does not decrease the risk of joint infection in general populations , but routine screening or prophylactic treatment of UTI in MS patients preoperatively may warrant consideration to reduce postoperative complications related to both spasticity and infection.
People With Ms May Experience Pain For Other Reasons Including:
- as a side effect of medication eg headaches or injection site reactions to disease modifying treatments
- as a result of infections, such as a bladder infection
- from an accident or other health condition not related to MS
It is common to experience more than one type of pain.
Treating MS pain may include drugs or non-drug treatments, such as physiotherapy. You can also make changes to your everyday life so that pain has less impact. Effective pain management often means trying a range of approaches to see which ones work best for you and then adopting several at once to get the best overall effect.
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How Is Multiple Sclerosis Diagnosed
A neurologist will also look at your personal medical history and then family medical history, because MS is thought to be genetic.
Hell ask you to move your arms and legs first, Hell then move your extremities. This is called active and passive range of motion.
This is to find out how well youre able to move your arms and legs, without causing pain.
A doctor might do a series of tests to make a diagnosis. Some of them might include MRI, spinal tap and evoked potential.
A doctor will use an MRI to take pictures of your brain and spinal cord, to establish the presence of a lesson.
Hell check for other abnormalities in these areas as well.If the doctors really concerned he might inject a metallic dye into your system.
This substance will leak around the abnormalities. In addition, he will check for volume loss due to atrophy.
If he diagnoses you with MS then its likely he will repeat this test periodically, to see how the disease and treatment is progressing.
Your neurologist might drain a little fluid off of your spinal cord, to see if it contains white blood cells.He will also check for oligoclonal band, to determine how well your immune system is doing.
Evoked potential is when a neurologist stimulates your nervous system by using either checkerboard pictures or clicking sounds.
He will then record how your nervous system reacts. This recording is usually taken from the nerves in the arms and legs.
What Can I Do If I Have Pain
You can manage your pain using drug treatments or other therapies, such as physiotherapy. Sometimes a combination of drugs or other treatments works best. Not all pain requires treatment, it depends on how much effect it is having on your life.
Managing pain may include learning coping strategies or making changes to everyday life so that pain has less impact on you. It is important to manage your pain as well as possible or you may lose sleep or become understandably irritable, angry or depressed.
In addition, other things that are happening in your life can make the pain feel better or worse so it is important to manage stress, get support and be as positive as possible about managing your pain. Like many MS symptoms, heat sensitivity or, sometimes, cold sensitivity can make pain worse. So can fatigue, lack of sleep, feeling isolated or depressed.
If you are concerned about your pain, contact your MS nurse orneurologistdirectly or ask your GP to refer you for assessment.
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How Does As Affect The Knees
Although AS is most common in the spine, any large joint can be affected usually in an asymmetric distribution. This means that only one knee might hurt, as opposed to both knees. The pain is usually dull, often described by patients as soreness. Its associated with stiffness that is worse in the morning and usually more intense after inactivity, he says. Pain and stiffness tend to improve with physical activity over an hour or more, Dr. Loupasakis says. The knee may feel warm to the touch and look swollen.
Still, how knee pain in AS feels is subjective and varies from patient to patient, says Erika Di Porto, DPT, MSPT, CI, department chairperson for the School of Health Sciences at Miami Dade College Medical Campus in Miami. The joint hurts. The pain envelops the muscles, tendons, and the joints, says Dr. Di Porto.
The pain in peripheral joints like the knee can be caused by arthritis or enthesitis , says Dr. Loupasakis. In arthritis, the knee can be swollen, warm, and tender. Enthesitis typically involves the Achilles tendons and the heels. But it can involve almost any part of the body at sites where tendons and ligaments attach to bones , he says. With enthesitis, the knee is not swollen but is tender to pressure, mostly at the front part around and below the kneecap.
Are There Known Triggers For Ms
Experts suspect a number of potential triggers or risk factors for MS. For example, some believe that its due to a chronic infection . Others believe that its primarily a genetic neurological disease. These theories challenge the idea that MS is primarily an autoimmune disease although there may be more than one trigger or combination of triggers that causes a person to develop MS.
Some studies suggest that head injuries might be a risk factor for MS. If true, it raises important questions about how MS develops and how it might be prevented. On the other hand, its not an easy thing to study because researchers would never intentionally cause head injuries to see if they cause MS. Another way to study this question is to enroll people who already have MS, look back at whether they had concussions, and then compare them with similar people who dont have MS.
A study published in the September 2017 issue of Annals of Neurology did just that.
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Intraoperative Care And Postoperative Planning
Our patient had significant lateral compartment contracture at the time of her surgery. Because the future stability of the knee is also a concern, it would seem reasonable to avoid tendon releases if possible. In our patient, sufficient range of motion was achieved without tendon releases however, she later developed severe contractures. Possibly targeting the lateral hamstrings with botulinum intraoperatively or earlier in the postoperative period may have prevented the contracture formation.
To ensure stability of the TKA, Rao et al. recommended in their case report a fixed-bearing posterior-stabilized prosthesis. A more constrained prosthesis in patients with severe spasticity may reduce the risk of dislocation. Although this was not needed for our patient, a previous dislocation was reported by Bron et al. .
While the recommended duration of treatment for thromboembolism prophylaxis is 10-35 days for general TKA populations , , as patients with MS may be slower to mobilize, we suggest that longer durations be considered. Although continuous passive motion devices may not be routine care in general orthopaedic TKA practices , these devices may have a role for patients with MS at higher risk for complications related to immobility.
If You Have Multiple Sclerosis And Toe Pain Or If You Have Unexplained Toe Pain But Have Not Yet Seen A Neurologist There Are Several Important Factors That You Need To Understand
Damage to the central nervous system can cause a variety of changes in sensation which result in a person experiencing pain, explains Mitzi J. Williams, MD, clinical neurologist with Morehouse School of Medicine, an MS specialist and clinical advisor for the Multiple Sclerosis Foundation.
The pain often occurs in the arms and legs or in the face.
People with MS can have foot pain and may also complain of pain in the toes.
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What Triggers Autoimmune Diseases
The most common explanation is that an affected persons immune system, partly due to the genes they inherited, is primed to react abnormally to some trigger, such as an infection, an environmental exposure , or some other factor. For most autoimmune diseases, we cant easily figure out what triggers them. If we could, we might be able to prevent them.
Living With Multiple Sclerosis
MS is a chronic illness with no known cure. However, a diagnosis is not a death sentence. There are ways for you manage the condition, so you can live a worthwhile and fulfilling life.
Here are some useful tips on how you can live an enjoyable and meaningful life with MS.
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Early Warning Signs Of Multiple Sclerosis
Multiple sclerosis, like a lot of the other autoimmune diseases has a range of symptoms.
The symptoms and their severity that fluctuates from person to person. Some of the more common early warning signs include tingling and numbness in different parts of your body.
A person might feel like an electrical current is running down their arm, legs or neck. Someone they might have generalize weakness.
A person might experience difficulty with walking. They may have blurry vision and sometimes they might see double.
They can have urinary urgency, or perhaps difficulty when they begin urinating.
Surgeries For Trigeminal Neuralgia
If medications arent enough to control the pain of TN, surgery may be necessary. Several types of operations are available.
The most common type, microvascular decompression, involves moving a blood vessel away from the trigeminal nerve. When its no longer pushing against the nerve, the pain may subside. Any nerve damage that occurred may be reversed.
Radiosurgery is the least invasive type. It involves the use of beams of radiation to try to block the nerve from sending pain signals.
Other options include using gamma knife radiation or injecting glycerol to numb the nerve. Your doctor can also use a catheter to place a balloon in the trigeminal nerve. The balloon is then inflated, compressing the nerve and injuring the fibers that cause pain.
Your doctor can also use a catheter to send an electric current to damaged nerve fibers that are causing pain.
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Axial Spondyloarthritis Vs Peripheral Spondyloarthritis: Whats The Difference
Ankylosing spondylitis is a type of spondyloarthritis , which is an umbrella term for different types of arthritis including psoriatic arthritis that have some traits and symptoms in common. There are two main types of SpA:
- Axial spondyloarthritis
- Peripheral spondyloarthritis
In axial spondyloarthritis, the inflammation is more confined to the spine, and occasionally the shoulders and hips, says Konstantinos Loupasakis, MD, a rheumatologist at MedStar Washington Hospital Center in Washington, D.C. More distal joints, such as the knees, may also be affected although this is more commonly seen in peripheral spondyloarthritis.
Within AxSpA, there are two categories:
- Ankylosing spondylitis is considered radiographic AxSpA, which means that evidence of joint damage is visible on X-rays.
- Non-radiographic axial spondyloarthritis is essentially the same condition, but without joint damage being visible on X-rays.
A non-radiographic axial spondyloarthritis diagnosis can be made if the patient has sacroiliac changes on an MRI or is positive for the HLA-B27 gene with symptoms of inflammatory back pain , says Neal Birnbaum, MD, a rheumatologist, former president of the American College of Rheumatology, and founder of Pacific Rheumatology Associated Medical Group in San Francisco.
Peripheral spondyloarthritis means that inflammation and joint pain affects the limbs more than the spine. Sites include the knees, as well as the hands, wrists, elbows, shoulders, and ankles.
Various Causes Of Ms Knees
The knee pain endured by multiple sclerosis patients is often the result of an uneven gait. Multiple sclerosis patients who develop an uneven gait do so because the development of lesions in their nervous tissue has significantly hindered their ability to walk normally. These patients may have vertigo and balance problems, which make it difficult for them to remain upright. They may also have poor coordination.
Some patients experience spasticity as their primary problem. Spasticity entails the continued contraction of certain muscles, and the patients inability to voluntarily make those muscles relax. When the leg muscles are spastic, it becomes impossible to walk unless the patient has the help of anti-spasticity medication and, in some cases, devices such as braces and canes. The medication helps to relax the muscles. As for the walking aids, they provide the patients with much needed support. In this way, they help to reduce the pain and injury associated with spasticity-induced MS knees. However, it is important to note that, even with medication and walking aids, patients are bound to have a limp or an uneven gait. Another MS-related cause of knee pain is the development of numbness and tingling in the feet. Understandably, these symptoms can cause an MS patient to lose balance and to have coordination problems, and these latter issues can contribute to knee pain. Muscle weakness is another MS symptom that has the capacity to contribute to knee pain in patients.
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