Multiple Sclerosis and Back Pain: Causes and Treatment

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Multiple sclerosis (MS) is a chronic autoimmune disease that destroys the myelin sheath, a protective covering of nerves. This causes consequences affecting several systems and regions of the human body.

Among the many symptoms arising from the disease, it is possible to develop back pain. This article explains the precise causes explaining this phenomenon, as well as treatment methods aimed at relieving the symptoms and improving the quality of life.

Definition

Multiple sclerosis (MS) is a disease that affects the central nervous system. It disrupts the flow of information between the brain and the rest of the body. The symptoms related to this condition are variable, and affect several systems of the human body.

Some of the most common symptoms associated with this disease include:

• fatigue (most common symptom)
• spasticity
• altered sensations
• motor disorders
• visual problems
• urination disorders
• cognitive disorders
• psychological disorders

Back pain is also a symptom often present in affected individuals. Indeed, research indicates that the percentage of people with multiple sclerosis who suffer from low back pain could reach 41,6%.

Causes of back pain in people with multiple sclerosis

How can back pain set in in people with MS? Here are the main causes that explain the link between this pain and the disease:

spasticity

Spasticity is a common symptom of MS. It is a stiffness of the muscles caused by muscle spasms. It usually manifests in the legs, groin and buttocks, but it can also affect the lower or milieu back. It is not necessarily painful all the time, but can be a source of discomfort and limit daily activities in some cases.

A number of factors can make spasticity worse, including:

• sudden movements
• position changes
• extreme temperatures
• tight clothes

Nerve damage

MS damages the nerves. This pain is called neuropathic pain, and is one of the most common symptoms of this disease. Certain factors aggravate this type of pain. We think for example of stress, fatigue, or even heatstroke.

This type of pain can manifest throughout the body. At the lumbar level, it may appear as a stabbing sensation. The affected person may also feel a burning sensation in the lower back which sometimes radiates to the legs.

Lhermitte's sign is a sign of nerve damage. In patients suffering from multiple sclerosis, it would be present in almost 33% of cases. It is basically a brief, intense pain that starts from the back of the head and travels down the spine, sometimes into the arms or legs. This pain is typically reproduced when a person tilts their head forward.

Musculoskeletal impairment

Because it often alters posture, walking pattern and joint mobility, multiple sclerosis can indirectly cause lower back pain and other musculoskeletal disorders.

For example, numbness in the legs can alter the walking pattern and cause compensatory mechanisms. This could cause the affected person to distribute their weight unevenly, putting more pressure on the lower back.

Another common situation is the stiffness of the hips which causes compensation at the lumbar level, and favors the appearance of pain at this level.

Other experience

Living with multiple sclerosis is a challenge in itself. The repercussions on lifestyle and the mind can indirectly increase pain. Indeed, the following factors have been linked to back pain, and can influence the prognosis in affected individuals:

• Depression and anxiety
• overweight
• Sedentary lifestyle
• Smoking
• Bad nutrition

It is therefore important to have a multidisciplinary and multifactorial approach when discussing the treatment of multiple sclerosis.

Treatment and prevention

Medication

It is not uncommon to be prescribed medication when consulting for back pain. In patients with multiple sclerosis, a doctor may also prescribe medication to reduce inflammation (anti-inflammatories), decrease muscle tension (muscle relaxants), or decrease nerve pain.

It is important to adjust the doses according to the medical history, symptoms and general condition of the patient. The doctor will follow up and ensure that the medications are working optimally and safely.

Kinesitherapy

The physiotherapist has an important role to play in the treatment of multiple sclerosis. His vast therapeutic arsenal allows him to use several modalities aimed at relieving symptoms and improving function.

For example, massage and stretching might reduce spasticity in conjunction with the application of heat. Electrical stimulation (TENS) can also relieve pain and decrease muscle tension caused by back pain.

In addition, an adapted therapeutic exercise program can help keep the person with multiple sclerosis active, in addition to correcting muscle and joint imbalances potentially responsible for back pain. Education on the integration of regular physical activity will help avoid a sedentary lifestyle, and maintain an active lifestyle.

occupational therapy

Occupational therapists take care of patients when a health problem limits their ability to perform personal care, their professional activity or restricts their quality of life.

For a person with multiple sclerosis, here is how the occupational therapist could intervene:

• offer technical walking aids (cane, walker, etc.)
• arrange the home to reduce the risk of falling and make it accessible
• establish a plan to return to work so that work tasks are adapted to the patient's abilities
• giving practical advice to reduce fatigue and improve activities of daily living and household

Psychology

Like any chronic disease, MS has a significant psychological impact. The resulting potential and variable disorders can greatly influence the quality of life, as well as that of those close to the affected person.

Also, the random nature of multiple sclerosis requires frequent reorganizations and adjustments. It is sometimes difficult to accept the break with the previous life, although this step is essential.

With this in mind, the psychologist has an important role to play in treating and preventing mood and emotional disorders. The following modalities can be used in psychology:

• psychotherapy
• cognitive behavioral therapy (CBT)
• couples therapy
• family therapy
• breathing techniques
• mindfulness meditation

Anti-inflammatory diet

The role of diet in the development of MS is the subject of debate in the scientific community. There is also a lot of contradictory information on the subject. This comes from the fact that to date, there are no scientific studies demonstrating with certainty that a change in diet would improve the prognosis of the disease.

However, no one can deny that a balanced diet can eliminate excess pounds, improve energy levels, and increase self-confidence. In this perspective, a anti-inflammatory diet could act against the inflammation caused by back pain, in addition to allowing weight loss.

To learn more about the anti-inflammatory diet, see the following article. 

Alternative therapies

Although not supported by solid scientific evidence, there are several alternative therapies that some individuals with multiple sclerosis use. Among the most popular are.

• acupuncture and acupressure
• reflexology
• yoga
• CBD (cannabis)
• cold water immersion
• natural products
• etc.

It is important to be followed by a professional (such as a homeopath or a naturopath), and to inform your doctor of any product consumed. This will make it possible in particular to avoid drug interactions, and to ensure the validity of the treatment in question.

Conclusion

MS is a disease that disrupts the flow of information between the brain and the rest of the body. This can cause a number of symptoms, including back pain.

There are many possible causes of low back pain in people with MS. The main ones are spasticity, nerve damage, and musculoskeletal disorders.

Fortunately, there are various modalities aimed at relieving back pain and helping sufferers improve their quality of life. Health professionals such as doctors, physiotherapists, occupational therapists, psychologists and others will be able to guide you and adapt the treatment according to your particular condition.

 

References

• https://www.medicalnewstoday.com/articles/multiple-sclerosis-back-pain#spasticity-and-muscle-tightness
• verywellhealth.com/lower-back-pain-and-ms-3972530#quote-11