Pain Management Through Surgery

Severe spasticity in the lower extremities can be associated with pain. In these cases, benefit may be obtained from an intrathecal (within the spine) baclofen pump, which delivers tiny doses of baclofen directly into the spinal fluid by a surgically implanted pump. Morphine can also be delivered this way.

Nerve blocks (injections of local anesthetic into the inflamed nerve) can also be used.

The fifth cranial nerve (trigeminal nerve) controls sensory innervation of the face, sinuses, and teeth, and motor function of the muscles of mastication (chewing).

Table 5.1

Origins of Pain in

Multiple Sclerosis

Origin

Where

Why

What Helps

Musculoskeletal

Sacral-tailbone area

Immobility causes

Swing legs back and

pain

and hipbone

pressure on body

forth, as in walking.

Muscles, tendons, and

Keeping a limb in a

Change position

ligaments

fixed position

frequently; practice a

"freezes" muscles so

few minutes of

it becomes painful

physical therapy daily;

to change position

sit in a rocking chair

with feet supported

at a 90-degree angle.

Spasms in muscles

When there is spinal

Try medication such

cord involvement,

as baclofen by mouth

flexor spasms occur.

or implanted pump,

tizanidine by mouth,

or clonazepam by

mouth. Move often to

decrease the severity

of spasms.

Sudden shortening

Keep a board at the foot

of large muscles can

of the bed; press ball of

result in cramps.

foot against it as soon as

cramp occurs. Watch

diet. Inadequate intake

of potassium can cause

muscle cramps.

Neurological pain

Burning or aching

Defective conduction

Apply warm compresses

sensations in the

of nerve impulses in

to the skin to relieve

limbs; tight or

the spinal cord and

burning pain; use

constrictive pain

brain results in

antidepressants such as

around the trunk

abnormal sensations.

amitriptyline to modify

how the central nervous

system reacts to pain. An

anticonvulsive, gabaper-

tin, may also help. Firmly

wrap an Ace bandage

over the area—but not

over the face—to alter

the sensation from pain

to pressure, being careful

that the bandage is kept

loose enough to allow

free circulation.

Sharp pain in the face

Baclofen, carbamazepine,

is called trigeminal

gabapentin, alone or in

neuralgia.

conjunction, have been

used successfully.

In severe cases of pain, surgery can be performed to cut some of the spinal sensory nerves. Called partial posterior rhizoto-my, these surgical cuts are irreversible.

In summary, pain can be a significant symptom of MS. A combination of modali ties often provides the best outcome. Physical therapy, emotional support, and drug therapy, along with a trusting relationship between patient and doctor, often prove the most helpful.

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