Multiple Sclerosis pain
Multiple sclerosis (MS), also known as “disseminated sclerosis” or “encephalomyelitis disseminata”, is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms. Disease onset usually occurs in young adults, and it is more common in women. It has a prevalence that ranges between 2 and 150 per 100,000. MS was first described in 1868 by Jean-Martin Charcot.
MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other effectively. Nerve cells communicate by sending electrical signals called action potentials down long fibers called axons, which are contained within an insulating substance called myelin. In MS, the body’s own immune system attacks and damages the myelin. When myelin is lost, the axons can no longer effectively conduct signals. The name multiple sclerosis refers to scars (sclerae-—better known as plaques or lesions) particularly in the white matter of the brain and spinal cord, which is mainly composed of myelin. Although much is known about the mechanisms involved in the disease process, the cause remains unknown. Theories include genetics or infections. Different environmental risk factors have also been found.
- A person with MS can suffer almost any neurological symptom or sign, including changes in sensation such as loss of sensitivity or tingling, pricking or numbness (hypoesthesia and paresthesia), muscle weakness, clonus, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis including phosphenes, or diplopia), fatigue, acute or chronic pain, and bladder and bowel difficulties. Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common. Uhthoff’s phenomenon, an exacerbation of extant symptoms due to an exposure to higher than usual ambient temperatures, and Lhermitte’s sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS although not specific. The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale or EDSS.
- Symptoms of MS usually appear in episodic acute periods of worsening (called relapses, exacerbations, bouts, attacks, or “flare-ups”), in a gradually progressive deterioration of neurologic function, or in a combination of both. Relapses occur more frequently during spring and summer. Viral infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse. Stress may also trigger an attack. Pregnancy affects the susceptibility to relapse, with a lower relapse rate at each trimester of gestation.
Fleming, JO (2013 Jan 5). “Helminth therapy and multiple sclerosis”. International Journal for Parasitology 43 (3–4): 259–74. doi:10.1016/j.ijpara.2012.10.025. PMID 23298637.
Myhr KM, Riise T, Vedeler C, et al (February 2001). “Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension”. Mult. Scler. 7 (1): 59–65. PMID 11321195.
Multiple Sclerosis Fact Sheet CDC medical records on VoxHealth. Retrieved on 2013-30-1
Pugliatti, M; Sotgiu, S, Rosati, G (2002 Jul). “The worldwide prevalence of multiple sclerosis”. Clinical neurology and neurosurgery 104 (3): 182–91. doi:10.1016/S0303-8467(02)00036-7. PMID 12127652.
Kulie T, Groff A, Redmer J, Hounshell J, Schrager S (2009). “Vitamin D: an evidence-based review”. J Am Board Fam Med 22 (6): 698–706.
Research directions on MS treatments include investigations of MS pathogenesis and heterogeneity; research of more effective, convenient, or tolerable new treatments for RRMS; creation of therapies for the progressive subtypes; neuroprotection strategies; and the search for effective symptomatic treatments. A number of treatments that may curtail attacks or improve function are under investigation. Emerging agents for RRMS that had shown promise in phase 2 trials before 2009 included alemtuzumab, daclizumab, rituximab, dirucotide, BHT-3009, cladribine, dimethyl fumarate, estriol, laquinimod, PEGylated interferon-β-1a, minocycline, statins, temsirolimus and teriflunomide.
Since MS has been related to vitamin D deficiency it has been proposed that vitamin D could be used to treat the disease. Clinical trials have been scarce, of low quality and have not shown clear indication of benefit.
While there is anecdotal evidence of benefit for low dose naltrexone, only results from a pilot study in primary progressive MS have been published
Many people with MS use complementary and alternative medicine. Depending on the treatments, the evidence is weak or absent. Examples are a dietary regimen, herbal medicine (including the use of medical cannabis), hyperbaric oxygenation and self-infection with hookworm (known generally as helminthic therapy). Helminthic therapy of infection with Trichuris suis ova is under investigation as of 2013, with expected results of a clinical trial in 2014. Preliminary data indicates that it may be safe and clinically useful.
The treatment is being carried out at Royal Hallamshire Hospital in Sheffield and Kings College Hospital, London and involves use a high dose of chemotherapy to knock out the immune system before rebuilding it with stem cells taken from the patient’s own blood.