Musculoskeletal pain (nociceptive pain)

Pain in our muscles, bones and joints is called musculoskeletal pain (MSK or nociceptive pain). It often happens in MS as a knock-on effect of other MS symptoms, such as changes to your mobility, muscle stiffness and spasms, and fatigue.

This page explains why you might experience musculoskeletal pain and how it can be treated and managed.

Musculoskeletal pain, or nociceptive pain, can happen when your muscles, tendons, ligaments or soft tissue are damaged. This can be caused by an injury, such as a sprain, fracture, pulled muscle or repetitive strain. It can also be caused by conditions such as MS. Musculoskeletal pain can be acute or chronic.

In MS, musculoskeletal pain commonly affects the neck, back, legs and arms. It often happens because of other MS symptoms. Several MS symptoms can affect how you move, how often you move, and your posture.

If you experience muscle stiffness and spasms, weakness in your muscles, or problems with your balance, you may change how you walk or move around. These changes may cause pain in your hips and back, for example.

MS symptoms like fatigue and walking difficulties may mean that you cannot be as active as you used to be. As a result, you may experience back pain if you end up sitting down for longer periods.

Muscle or joint pain can also happen because of changes to your posture when sitting, standing or lying down. Muscle weakness or spasms can make it more difficult to maintain good posture.

You may also experience muscle pain if your MS causes your muscles (for example, in your legs) to become stiff or spasm.

Musculoskeletal pain should always be assessed by a health professional to work out the cause and recommend appropriate treatment options.

If you are concerned about your pain, contact your MS team or ask your GP to refer you for an assessment.

Your GP or MS team may recommend common pain-relieving drugs, such as paracetamol, ibuprofen or aspirin, to reduce musculoskeletal pain. These are over-the-counter medications that can be bought from pharmacies and supermarkets.

If these drugs don't work or you experience unwanted side effects, your GP or MS team may recommend weak opioids, such as codeine. In cases of more intense, chronic pain, you may be offered steroid injections to reduce the inflammation and relieve the pain.

The NHS website has more information on these drug treatments: paracetamol, ibuprofen, aspirin, codeine, steroid injections.

If the pain is due to muscle stiffness and spasms, there is a wider range of drug treatments that may be offered. Read more about treatments for spasticity and spasms

Although drug treatments may help to ease the pain, your health professional may recommend rehabilitation therapies alongside this to treat the underlying cause.

Your MS team or GP should review your treatment regularly and suggest alternatives if something is not working well.

A physiotherapist can help you maintain and improve movement and function if MS has affected your mobility. There are some physiotherapists who specialise in treating people with neurological conditions like MS (known as neurophysiotherapists).

A physiotherapist can identify any changes in your posture or walking (gait) that may be causing pain. They can also advise you on exercises to strengthen certain muscle groups to improve your flexibility, keep you mobile and reduce your pain. If you have difficulty moving, a friend, family member or carer may be able to gently help you stretch.

If your pain is due to posture changes when sitting, standing or lying down, a physiotherapist can help you to improve your posture and relieve the strain on painful joints or soft tissues. A referral to the wheelchair clinic may also be helpful to be assessed for devices, like shaped cushions or T-rolls, to use in your chair to improve posture.

An occupational therapist (OT) can suggest equipment that might help you at home, at work, or when getting out and about. For example, they may suggest equipment to make moving around your house safer and easier, such as grab rails, perching stools and walking aids, reducing the strain on your muscles and joints. OTs may also suggest lifestyle changes to make things easier for you and help relieve your pain.

An orthotist can provide external devices (orthoses) that support your bones and joints. These devices can help you maintain and improve mobility and function in various parts of your body. For example, a brace that supports your ankle and foot can help with walking difficulties like foot drop, or a device that supports the position of your hand and wrist (a resting splint) can help with painful muscle contractures.

Orthotists usually work closely with OTs and physiotherapists. You can be referred to an orthotics service by your GP or MS team.

Rehabilitation, usually abbreviated to rehab, can reduce the impact of symptoms or disability on daily life. It can help you to live life as fully as possible and minimise the impact of your pain on work, education and family life. You may work with a multidisciplinary team that includes a rehab consultant, nurses and therapists.

Living with pain in the long term can understandably have an impact on your mental health. If you're noticing a change in your mood and you're feeling particularly low, you may want to consider reaching out for support from a psychological therapy service.

Turning to psychological therapies does not mean that the pain you're experiencing is all in your head – your pain is real. These services offer therapies to help you develop coping strategies and change how you respond to pain. They may offer therapies such as counselling, cognitive behavioural therapy, mindfulness and acceptance and commitment therapy.

Your GP or MS team can refer you to your local service. Alternatively, if you live in England, you can self refer. Find your local talking therapy service (NHS.UK)

Read more about psychological therapies

TENS (transcutaneous electrical nerve stimulation) is the application of small harmless electric signals to reduce pain. TENS may temporarily ease some types of musculoskeletal pain, such as pain caused by muscle stiffness and spasms.

You can buy or rent TENS machines online or from a pharmacy, however it's best to seek advice from a health professional to assess whether it'd work for you and to show you how to use one. Physiotherapists can help with this and specialist pain services.

If your pain is severe and it's significantly impacting your wellbeing and your daily activities, your GP or MS team may refer you to a specialist pain service.

A pain service is made up of a team of health professionals to support you with pain management. This can include:

• pain consultants
• specialist nurses
• physiotherapists
• psychologists
• occupational therapists
• pharmacists.

Some pain services are attached to local hospitals, others are based in the community.

When you first visit a pain clinic, you'll have an initial assessment to help the team understand your pain. This may involve a physical examination, answering questions around how your pain affects you physically and emotionally, and a review of your current medication.

They can then create a management plan. The plan may cover things such as changes to your medication and psychological support. It may also include education programmes to support you with lifestyle changes in aspects like physical activity, sleep and relaxation.

Pain services cannot offer a quick fix for pain, but they can support you to make changes, so you can manage your pain as best as possible.

It's not always possible for drug treatments and rehabilitation therapies to get rid of your pain completely. Other ways to manage pain include learning coping strategies and making changes to everyday life so that pain has less impact on you.

There is plenty you can try to see if it helps. Everyone is different so you may need to try a range of different options before you find what works best for you. You may need to do several at once for the best effect. 

Being less active, due to pain or other MS symptoms, can cause a gradual loss of strength and fitness. This is called deconditioning and can make your pain worse. Although it may feel hard to get started initially, regular activity can reverse deconditioning and help ease your pain. Keeping active can also be therapeutic and improve your mood, helping you to cope better with pain.

You do not have to do vigorous exercise to be more active. You could try gentle forms of exercise that focus on stretching, breathing, posture and movement – such as yoga, Pilates or Tai Chi. You could also speak to a physiotherapist for tailored exercises to suit you. Other options include walking, swimming or going to the gym.

Many options can be done at home or as part of everyday life. The most important thing is to find something that you enjoy, and which helps, rather than aggravates, your pain.

Explore our range of accessible exercise resources

Small changes to your posture can make a big difference to pain, especially in the back and neck. Try placing a rolled-up towel in the small of your back to ensure that your spine is held in a good position. Regular upright standing against a work surface or in a standing frame can also help to improve posture and reduce muscle or ligament pain.

See our resources that can help you assess and correct your posture in various positions

It can be tempting to lie down or sit still for long periods if your pain is troubling you. But it's better to move around regularly if you can. You could try small regular changes of position when seated or getting up for a little walk around. If it is difficult for you to move, a friend, partner or carer may be able to help with general stretching exercises. These small gentle movements may ease the painful feelings.

Although it's important to keep active, listening to your body and resting when needed can be key in pain management too.

You may find that if you do too much, your pain feels worse. Pacing yourself involves breaking down large tasks into smaller chunks and taking regular, short breaks before you overdo it. For example, doing the washing up in short bursts or spreading out the cleaning over several days. This can seem frustrating at first, but it can help with managing pain levels.

Think about how you carry out everyday tasks. Are they potentially making your pain worse? How could you do things differently?

You might buy a more supportive mattress, do the ironing while sitting on a stool or order your groceries online so you do not have to carry heavy shopping. Think carefully about why you do something the way that you do – it can be surprising how often it is just out of habit. Challenge yourself to think creatively so that you come up with new ways of doing things that are kinder on your body and ease your pain. Ask your family, friends and colleagues to work with you so that they understand how these changes will help you.

As other MS symptoms can indirectly cause musculoskeletal pain, it's important to keep on top of managing those symptoms. If you're struggling with fatigue, muscle stiffness and spasms, changes in your mobility or balance issues, reach out for support from your MS team. It's important to keep up with any medications, rehabilitation therapies or other management strategies that have been recommended.

It can be useful to be aware of what can aggravate or trigger muscle stiffness and spasms.

Although heat sensitivity can make MS symptoms worse for many people, heat applied to the affected area can be helpful. You could try using a hot water bottle or heat pad. A hot bath can be good for pain, as long as it doesn't make your other symptoms worse.

Some people find that applying ice or a cold pack helps. Ice should be wrapped in a tea towel, not applied straight to the skin, or you could try a pack of frozen peas.

Many people find that keeping a diary of their symptoms helps them to manage their MS better from day to day. You might like to note in your diary when you experience pain, how it feels and what else is happening with your MS and in the rest of your life. This may help you to work out if there are factors that trigger or aggravate your pain so you can make changes to manage it better. One way of grading pain is to describe it as a number between 0 and 10, where 0 = no pain and 10 = the worst pain imaginable. Keeping a daily diary of your pain levels may help you discover whether interventions are working to reduce the pain.

Although high-quality research is lacking, there is some evidence that complementary therapies, such as reflexology, acupuncture and massage, can help with pain in MS.

Read more about complementary therapies you could try.

Pain can be difficult to ignore at times. It can end up becoming the focus of your thoughts. You could try to distract yourself by doing something you like or something that is important to you. That could be watching a film, reading, going for a walk, listening to music, doing a crafting activity, doing a puzzle or playing a game. This may take the pain away from the forefront of your mind.

You may become tense if pain is having an impact on how you feel and how much you can do. This tension may increase your pain and may create other aches and pains which add to your discomfort.

There are many relaxation techniques that can help with this. You could try deep breathing exercises, visualisation techniques, massage, mindfulness, meditation, hypnotherapy or gentle yoga stretching exercises. You might also like to try restful things that you enjoy like listening to music, meeting a friend for a coffee, gentle walking or sitting outdoors.

Read more about relaxation techniques

Pain is one of the invisible symptoms of MS. Even people close to you may not notice that you're in pain. It can be good to share how you're feeling and to ask for help when you need it. Reach out to a family member or friend – someone you can trust. Some people find it helpful to join groups like the MS Trust Facebook group to ask questions and share experiences with others who have also experienced pain due to MS.

Dealing with pain can be draining physically and mentally. It can be hard to stay positive at times. If you're feeling very low, it might be time to reach out for professional support. Talk to your GP or MS nurse – they can refer you for psychological support.

There are also organisations that support people with pain. They have helplines, magazines, forums and self-management toolkits to support you. Find out more about organisations that can support you with pain

On days where your pain feels less intense and overwhelming, ignore the things that need to be done and focus on something you want to do instead. That might be sitting in the garden, listening to a podcast or baking a cake – do whatever brings you joy.

• NICE guideline – Multiple sclerosis in adults: management
• Directory of NHS pain management services in the UK from the British Pain Society.
• Pain Concern has a helpline staffed by volunteers who provide information, support or just a listening ear to people wanting to talk about their own pain or that of a family member or friend. They also have a magazine, a forum where members share experiences, online publications and a podcast.
• Pain Association Scotland provides self-management resources for people experiencing long-term pain.
• The Pain Toolkit provides online courses to help people self-manage persistent pain.
• Flippin' Pain has resources to help people understand the science behind pain, rethink how they respond to it, and feel more in control.
• Health Talk shares people's personal experiences of living with chronic pain.
• British Pain Society has a range of publications and leaflets for people experiencing long-term pain.
• Action on Pain provides support and advice to people affected by chronic pain.
• Live Well with Pain has tools and resources to help people learn new skills to self-manage persistent pain.