Pain and Multiple Sclerosis
Many options are available to treat pain in patients with multiple sclerosis.
Anticonvulsant Drugs Offer Relief continued...
The good news: Most pain in MS can be treated. There are more than half a
dozen of these anticonvulsants, and they all have a slightly different
mechanism of action and different side effects. The side effects of these drugs
can also include low blood pressure, possible
seizures, and dry mouth. They can also cause some weight gain.
"Some drugs are so similar to each other that if one drug in the class
fails, another is unlikely to work," says Hawker. "That's not the case
with these. Which one you use for which patient depends on the side effect
Finding the right anticonvulsant is all about trial and error,
says Bethoux. "We'll start them at the lowest possible dose of one
medication and increase it until the person feels comfortable or until side
effects aren't tolerable. If one medication doesn't work, we'll try
another," he says. "It's a process that can take a long time, but it's
the only way we have to do this."
New Frontiers in Treatment
Some patients, however, still haven't found the right drug and
the right dosage to control their pain. "About 1% to 2% of patients have
extremely refractory pain that's very hard to manage," says Kraft. So MS
experts are still looking for options to add to their treatment arsenal.
One intriguing possibility: Botox. The anti-wrinkle injections
popular with Park Avenue socialites have shown promise in helping to control
some types of MS pain. Botox, which acts locally to temporarily paralyze a
nerve or muscle, has been used for years at some multiple sclerosis clinics,
including Hawker's, to manage spasticity and bladder problems.
"Serendipitously, we found that it also seemed to have an effect on
pain," she says. "It's far from being a known treatment for pain in MS
at this point, but it's an exciting possibility."
UTSW, along with two other centers, will soon be launching a
small study involving about 40 patients with MS to assess whether Botox can
indeed relieve the stabbing pain of trigeminal neuralgia. "There are no
systemic side effects, only mild local facial weakness. The biggest drawback is
that you can only inject it in a limited area, so even if we do find that it's
effective against MS pain, Botox will certainly not replace any of the
medications we currently have. But it may be used in very specific conditions
like trigeminal neuralgia," Hawker says.