Multiple Sclerosis and Facial Pain

What is multiple sclerosis (MS)?

MS is a chronic disease of the central nervous system. MS can include a wide variety of symptoms and signs, including numbness, paresthesias, pain, weakness, spasticity, fatigue, vertigo, visual difficulties, gait dysfunction, bladder disturbances, and cognitive changes. There appears to be a genetic component to this disease, but the cause of MS is still unknown. Scientists believe that a combination of environmental and genetic factors contribute to the risk of developing MS. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease.

MS and facial pain

In MS, damage to the myelin coating around the nerve fibers in the central nervous system (CNS) and to the nerve fibers themselves interferes with the transmission of nerve signals between the brain, spinal cord and the rest of the body. Disrupted nerve signals cause the symptoms of MS, which vary from one person to another and over time for any given individual, depending on where and when the damage occurs.

Facial pain occurs in 1.9-6% of patients diagnosed with multiple sclerosis. In a small percentage of patients, it may be the only presenting symptom. For patients with an established diagnosis of MS, trigeminal neuralgia is the most common associated symptom. When trigeminal neuralgia (TN) is caused by MS, it is referred to as secondary trigeminal neuralgia- there is an underlying disease causing your facial pain. Trigeminal neuralgia almost always occurs on one side of the face, although in MS patients, it occurs more frequently on both sides, in about 18 percent of cases.

Facial Pain in MS is typically:

  • Sudden, intense, sharp, superficial, stabbing
  • Lasting from a second to several minute
  • May involve more than one part of the face on the same side
  • Brought on by a trigger
  • May be bilateral (on both sides)

Treatment for facial pain due to MS

Surgical therapy is controversial. The early reports found radiofrequency rhizotomy to be useful for the initial treatment of pain; however, the recurrence rate of pain is higher and the duration of pain relief may be shorter. Radiofrequency treatment for TN-MS is still the procedure of choice for most patients. Glycerol treatment may also be an option. Some numbness needs to be produced for the best and longest-lasting results. Studies of MVD surgery for patients with MS have shown a pattern: good initial pain relief with less sustained results. The majority of the FPA Medical Advisory board do not favor MVD for these patients. At the current time, radiofrequency and glycerol procedures have the clearest indications, with more information needed over time for the remaining choices.

People with MS can experience a wide variety of symptoms and signs, including numbness, parenthesis, pain, weakness, spasticity, fatigue, vertigo, visual difficulties, gait dysfunction, bladder disturbances and cognitive changes. As pain can be present in other sites in the course of MS, there are several reports of gabapentin, and lamotrigine being useful for pain in MS. In general, patients with MS are less likely to tolerate the medications used for TN.

For more information on MS, visit the National MS Society.

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By filling out the form below, you will receive a free FPA Patient Guide and periodic updates on the management and treatment of facial pain conditions. We do not share this information with any outside sources.