The Multiple Sclerosis "Hug"

The infamous girdle-band sensation can be quite painful

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Perhaps one of the oddest pain-related symptoms is the "MS hug" (a.k.a. girdle-band sensation, girdling, or banding)—the feeling like there's a tight band around the chest and ribs. This can come and go over the course of several weeks and range from an annoying pressure to abject pain. Though it's common in MS, this type of pain tends to be one of the most annoying and uncomfortable symptoms that MS patients experience.

What the Pain of an MS “Hug” Might Feel Like
Verywell / JR Bee

Symptoms

Like many MS symptoms, the MS hug feels different for each individual. It can also feel different in the same people on different days or at different times of the day.

The pain of an MS hug has been described in many unique ways, including:

  • Sharp
  • Dull
  • Burning
  • Tickling
  • Tingling
  • Crushing or constricting
  • Pressure

This pain usually occurs somewhere in between your neck and your waist.

You might only feel it on one side or in one small area; at other times, it can wrap around your entire torso. The pain can occur in waves that last seconds, minutes, or hours, or it can be steady for longer periods of time.

Like other symptoms of MS, this type of pain can intensify or be triggered by fatigue or stress. It can also sometimes be accompanied by a sensation of difficulty breathing, which is why it may be perceived as a heart attack or panic attack.

Chest pain needs to be taken seriously. Be sure to seek immediate medical attention if you experience severe chest pain and/or you're also having difficulty breathing or other signs of a heart attack. Even if you think it's simply MS-related, see a doctor to be on the safe side.

Causes

The MS hug is caused by a lesion or an area of active inflammation within the spinal cord. This means that the myelin sheath, the coating that insulates nerve fibers, has been damaged. The type of pain caused by the MS hug is technically classified as a neuropathic type of pain, also called dysesthesia, which refers to any abnormal sensation.

The sensation itself is the result of tiny muscles between each rib called intercostal muscles going into spasm. These muscles have the job of holding your ribs together, as well as keeping them flexible and aiding in movement, such as forced expiration.

However, like everything related to MS, the root cause of the MS hug has to do with damage to the myelin sheath.

In cases where you've already been diagnosed with MS and the MS hug starts up suddenly along with other symptoms, it's possible that you're having a relapse.

Diagnosis

Years ago, people thought MS was a painless disease, even doctors. Now scientists know that this isn't true. In fact, research shows that likely more than half of people with MS experience pain at some point in their disease course. Besides the MS hug, other types of pain include trigeminal neuralgia, abnormal sensations in your legs and feet, and Lhermitte's sign.

While you should not be shy about sharing details of your discomfort with your doctor—information that can help lead to a diagnosis—your doctor will still need to do a thorough workup if your symptoms are similar to those of MS hug because a number of other health conditions can mimic it.

Differential Diagnosis

In addition to a heart attack and a panic attack, the following need to be ruled out to confirm the diagnosis of MS hug:

  • Gallbladder disease
  • Stomach or intestinal infection
  • Lung disease
  • Inflammation of the cartilage between the ribs (called costochondritis)

If these other causes have been ruled out and you have already been diagnosed with MS, your neurologist may want to order a magnetic resonance imaging (MRI) scan to see if you're having an MS relapse, as you may need steroids if your symptoms are severe or debilitating.​

Treatment

If your doctor determines that your hug pain is indeed MS-related, there are some ways it can be treated, depending on the severity of your pain and whether or not you're having a relapse. In many cases, you won't need treatment and the pain will pass on its own.

Medications

For severe cases of MS hug in which you're experiencing a lot of pain or it's lasting a long time, your doctor may prescribe medication (or a combination of medications) to help, such as:

  • A muscle relaxant like Lioresal (baclofen) or Zanaflex (tizanidine)
  • An antispastic drug such as Valium (diazepam) or Ativan (lorazepam)
  • An anticonvulsant like Lyrica (pregabalin) or Neurontin (gabapentin)
  • An antidepressant such as Cymbalta (duloxetine) or Elavil (amitriptyline)

Some doctors have used Botox (botulinum toxin) injections to selectively reduce muscle spasticity. Botox blocks a chemical neurotransmitter called acetylcholine, allowing your muscles to relax. Treatment is typically indicated for those with severe pain and can last for up to six months with relatively few side effects (mainly injection site pain or redness). Botox is also commonly used to treat severe MS-associated bladder dysfunction.

If your doctor thinks that your symptoms indicate a true MS relapse, he or she may prescribe a course of a high-dose corticosteroid known as Solu-Medrol.

Home Treatments

While it would be nice to be able to erase the pain of MS with a simple pill, that's usually not the case. Instead, many people manage their MS pain by embracing tried-and-true home remedies used by others who experience similar discomfort.

Some of these methods, which can be used to manage other MS pain as well, include:

  • Applying direct pressure to the pain with the flat of your hand
  • Wrapping the affected area tightly with an elastic bandage or wearing tight clothing (some people feel this helps their brains deal with the constricting feeling better)
  • Practicing deep breathing to expand your chest and minimize spasms
  • Wearing lightweight, loose clothing
  • Applying an ice pack wrapped in a thin towel directly to the pain (unless the pain was triggered by cold)
  • Taking a warm bath or applying an electrical or microwaveable heating pad (unless the pain was triggered by humidity or heat)
  • Using topical analgesics such as IcyHot or lidocaine creams
  • Taking a pain reliever like Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) such as Advil or Motrin (ibuprofen)
  • Moving around, whether it's shifting your position, occasionally getting up and walking, or engaging in regular exercise
  • Getting a massage

Trial and Error

Because of the individual nature of pain, you may need to try a variety of methods before you find what works for you. It may also take a number of strategies used together to combat your MS pain.

A Word From Verywell

Even though MS hug pain is a common occurrence, this doesn't make it any less difficult to deal with, especially if you haven't experienced it before. If your pain isn't going away or you're unable to relieve it using home treatments, be sure to talk to your doctor about prescription medication options that can help. And as with any chronic condition, work to make your lifestyle as healthy as possible to help minimize your MS pain by eating a healthy diet, getting adequate sleep, staying hydrated, learning relaxation techniques to combat stress, keeping appointments with your doctor, and staying active as much as you're able.

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