my-ms logo my-ms title
Diagnosing and Treating Pain
There is no way to tell how much pain a person has. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. Sometimes, as in the case of headaches, physicians find that the best aid to diagnosis is the patient's own description of the type, duration, and location of pain. Defining pain as sharp or dull, constant or intermittent, burning or aching may give the best clues to the cause of pain. These descriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a patient with pain.

Assessing MS Pain

Pain is measured by what the person with pain says it is. Pain is measured by doctor’s on a numeric scale of ‘no pain’ to the ‘worst ever pain’. Pain is measured by the affect it has on activities of sleep, play, work, relationships and mood. The measures help providers understand the intensity and the severity of pain, and whether treatments for pain are making a difference. Keeping a pain journal, recording when, where and how long pain lasts, describing the pain (aching, pulling, sharp, cramping, burning, stabbing), recording what makes pain better or worse and what treatments are used is important to appropriate pain treatment.

Perhaps one of the most commonly used pain scales in healthcare, the numerical rating scale offers the individual in pain to rate their pain score. The numerical scale gives the option to verbally rate their scale from 0 to 10 or to place a mark on a line indicating their level of pain. 0 indictates the absence of pain, while 10 represents the most intense pain possible. This allows the healthcare provider to rate pain as mild, moderate or severe, which can indicate a potential disability level.

The Pain Scale

Mild Pain – Nagging, annoying, but doesn't really interfere with daily living activities

1 - Pain is very mild, barely noticeable. Most of the time you don't think about it.
2 - Minor pain. Annoying and may have occasional stronger twinges.
3 - Pain is noticeable and distracting, however, you can get used to it and adapt.

Moderate Pain – Interferes significantly with daily living activities

4 - Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting.
5 - Moderately strong pain. It can't be ignored for more than a few minutes, but with effort you still can manage to work or participate in some social activities.
6 - Moderately strong pain that interferes with normal daily activities. Difficulty concentrating.

Severe Pain – Disabling & unable to perform daily living activities

7 - Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships. Interferes with sleep.
8 - Intense pain. Physical activity is severely limited. Conversing requires great effort.
9 - Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.
10 - Unspeakable pain. Bedridden and possibly delirious. Very few people will ever experience this level of pain.

Measuring pain can also be done by using The World Health Organization (WHO) "pain ladder" to describe its guideline for the use of drugs in the management of pain. The general principle is to start with first step drugs, and then to climb the ladder if pain is still present. The medications range from over-the-counter drugs with minimal side-effects all the way to powerful prescription drugs.

This type of scale may, however, seem a bit simple and not be able to determine a more precise number to match the level of pain. Sometimes "things" might fall between a set of colors or numbers.

Three Level Pain Ladder

Mild Pain

Mild pain is self-limited. It goes away either with no therapy at all or with the use of nonprescription medication such as acetaminophen (Tylenol), aspirin, or other non-steroidal anti-inflammatory drugs (NSAIDs).

Moderate Pain

Moderate pain is worse than mild pain and can interfere with function. You may be unable to ignore the pain and go on with all of the activities of daily living, but it goes away after a while and doesn't come back after it has been treated. Moderate pain may need stronger medications than acetaminophen or nonprescription NSAIDs. Most NSAIDs, including ibuprofen (Motrin), have been found to be as effective at relieving pain as codeine.

Severe Pain

Severe pain is defined as pain that interferes with some or all of the activities of daily living. May cause bed confinement or chair rest because of the severity. Typically doesn't go away, and treatment needs to be continuous for days, weeks, months, or years. For severe pain, strong opioids such as morphine, oxycodone, hydrocodone, hydromorphone, methadone, or fentanyl, as well as other medications (called adjuvant therapies) as needed for the particular kind of pain.

img

Enlarge by passing over or clicking

image info This image is Copyright © My-MS.org and falls under Image License E defined under the Image License section of the Disclaimer page.

Recognizing that the severity and intensity of pain is influenced by anxiety, stress and depression is important to pain treatment. Understanding the influence of individual beliefs about pain, such as negative thinking that pain is overtaking life is important to managing pain. Recognizing individual strengths and coping strategies is important to managing pain. Finally, knowing who is there to help is important to pain management.

Physicians, however, do have a number of technologies they use to find the cause of pain. Primarily these include:

• Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies:
EMG can help physicians tell precisely which muscles or nerves are affected by weakness or pain. Thin needles are inserted in muscles and a physician can see or listen to electrical signals displayed on an EMG machine.
Nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle. The second set of electrodes is used to make a recording of the nerve's electrical signals, and from this information the doctor can determine if there is nerve damage.
EP studies also involve two sets of electrodes-one set for stimulating a nerve (these electrodes are attached to a limb) and another set on the scalp for recording the speed of nerve signal transmission to the brain.
• Imaging, especially magnetic resonance imaging (MRI), provides physicians with pictures of the body's structures and tissues. MRI uses magnetic fields and radio waves to differentiate between healthy and diseased tissue.
• A neurological examination in which the physician tests movement, reflexes, sensation, balance, and coordination.
• X-rays produce pictures of the body's structures, such as bones and joints.

To help with the pain and its reduction, exercise and physical therapy may help to decrease spasticity and soreness of muscles. Those with MS, however, may not always have the ability or endurance to do sufficient aerobic exercise. Regular stretching exercises do tend to help flexor spasms.

Relaxation techniques such as progressive relaxation, meditation and deep breathing can contribute to the management of chronic pain. Other techniques which may help pain include massage, ultrasound, chiropractic treatments, hydrotherapy, acupuncture, transcutaneous nerve stimulation (TENS), moist heat and ice.