An Overview of Dysesthesia in Multiple Sclerosis

More than half of people with multiple sclerosis (MS) experience pain. A specific type of pain known as dysesthesia is especially common. This pain is neurogenic, meaning it occurs as a result of MS-related nerve fiber damage in the central nervous system. The hallmark symptom of dysesthesia is a burning sensation, like a sunburn or electric shock, in certain areas of the body.

The discomfort or pain of dysesthesia most often affects the feet or legs, but it also can be felt in the arms and torso.

It's important to note that people describe dysesthesias in different ways, so the painful sensation you are experiencing may feel different from someone else's. Different types of pain described by people with MS include:

A classic example of a dysesthesia experienced by some people with MS is the "MS hug." This pain syndrome often causes an intense sensation of aching, burning, or “girdling” around the abdomen or chest area. For some people, this can be quite debilitating, whereas for others it's more of an annoyance.

Another classic example of a dysesthesia in MS is burning hot feet. This painful sensation tends to flare at night or after exercise. The opposite—ice cold feet—is also possible.

In some cases, dysesthesia manifests as pain caused by something that shouldn't hurt at all, such as a light touch or caress; this is called allodynia.

The abnormal sensations characteristic of dysethesia are caused by damage to nerves in the brain and spinal cord by MS. The normal transmission of messages to and from the brain is impaired by the disease, making it difficult for the brain to interpret the signals it is receiving.

As such, sensations in dysesthesia are not a sign of damage to the tissues where they are being felt, but due to the damage in the nerves that communicate with the brain about what’s happening in a particular part of your body.

Your doctor will diagnose dysesthesia based on the symptoms you report. Because there are many other types of MS-related changes in sensation, the diagnosis will largely depend on ruling those out.

For example, dysesthesia should not be confused with anesthesia or hypoesthesia, which refer to a loss of sensation, or paresthesia which refers to a distorted sensation (such as when a limb "falls asleep").

While there is no cure for dysesthesia, most people can learn to manage it. Here are some simple strategies that may ease your pain:

• If pain or burning is located in the hands or legs, you may consider wearing compression gloves or stockings. These convert the sensation of pain to a less uncomfortable feeling of pressure. It's like playing a trick on your brain, so to speak. These products are available at drugstores.
• Warm up too-cold feet by applying a warm compress to your skin; choose a cool compress if your feet are burning.
• Try over-the-counter capsaicin cream, which may provide some relief.
• Keep in mind that distraction can go a long way to take your mind off physical discomfort. Becoming engrossed in a book or movie, listening to music, or calling a friend can help you temporarily ignore your pain.

If these tactics don't provide enough relief, certain medications may help, especially if your painful sensations are impairing your everyday functioning and quality of life. Some medications that may be helpful include:

• Medications typically prescribed to treat seizure disorders, such as Neurontin (gabapentin) and Lyrica (pregabalin)
• Certain antidepressants. For example, the serotonin-norepinephrine reuptake inhibitor Cymbalta (duloxetine), or tricyclic antidepressants including Elavil (amitriptyline), Pamelor (nortriptyline), and Norpramin (desipramine)
• Anti-anxiety medications like the benzodiazepine Klonopin (clonazepam)

Engaging in certain mind-body therapies can also help alleviate your discomfort. Some complementary therapies that may be particularly useful for managing MS pain include:

• Mindfulness meditation
• Cognitive-behavioral therapy
• Diet
• Acupuncture

Abnormal sensations are common in MS and do not generally require treatment unless they impair day-to-day functioning or are new, which may indicate an MS relapse or another health condition.

While the pain associated with dysesthesia can be physically and emotionally draining, with the right interventions, you can feel better. In addition, sensory symptoms, including painful ones, are usually not dangerous. However, be sure to see your doctor if the sensations you are experiencing are new or worsening.