Navigating neuropathic pain in MS

Neuropathic pain is caused by damage or dysfunction of the nervous system, often due to trauma, surgery, disease or chemotherapy. Unlike nociceptive pain, which results from actual or potential tissue damage in areas like muscles, joints, or internal organs, neuropathic pain originates from malfunctioning nerves themselves.

Characteristics and causes

Neuropathic pain can present as burning, throbbing, coldness or electric shocks. It may accompany tingling, numbness, itching or hypersensitivity. Primary causes include conditions such as Complex Regional Pain Syndrome (CRPS), multiple sclerosis (MS), and postherpetic neuralgia. Other disease like fibromyalgia have neuropathic components. Without timely and effective treatment, neuropathic pain can become a disabling, invisible burden.

Pain management approaches

Management typically involves treating the underlying cause and using targeted therapies to control symptoms. As no single medication works for all individuals, treatment often involves a combination of medications and a trial-based approach to find the best balance between pain relief and tolerability.

Pharmaceutical treatments

Common medications include certain antidepressants and anticonvulsants, which help modulate nerve activity and reduce pain signalling. These include tricyclic antidepressants such as amitriptyline (Endep), serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafexine (Effexor), and anticonvulsants such as gabapentin (Neurontin) or pregabalin. Finding the right medication can require several trials and may require multiple trials and can take up to six weeks for assess effectiveness.

Role of common adjuncts and opioids

Whilst paracetamol (Panadol) is widely used for general pain, its role in treating neuropathic pain is limited. In some cases, it is combined with codeine for short-term relief. Opioids may be considered for severe or breakthrough pain if other treatments have failed, but their long-term use in neuropathic pain is generally discouraged due to limited benefit and risk of dependence. When prescribed, they are typically used at the lowest effective dose and monitored closely.

Medicinal cannabis

With expanding research and regulatory access, medicinal cannabis is now used in Australia for conditions such as multiple sclerosis (MS), particularly for symptoms such as muscle spasticity and neuropathic pain. Products containing tetrahydrocannabinol (THC), while potentially beneficial, are subject to strict controls and may affect legal responsibilities such as driving or employment. Medical supervision is essential when considering these options

Non-pharmaceutical approaches

Effective pain management includes a holistic biopsychosocial approach – addressing not just physical symptoms, but also lifestyle and mental health.

Strategies may include exercise, relaxation techniques, healthy sleep and nutrition, and support for emotional wellbeing. Multidisciplinary teams involving pain specialists, psychologists, physiotherapists and occupational therapists can help individuals build active self-management skills, often achieving better outcomes than medication alone.

Managing neuropathic pain requires individualised holistic care. Whether you live chronic pain, or support someone who does, connecting with healthcare providers can build a personalised, comprehensive management plan.

Pain is real, even if invisible and early, effective intervention improves quality of life.

MS Nurse Advisors provided a free phone-based service providing information, support, guidance and resources to those experiencing chronic neurological pain.