Nerve pain (neuropathic pain)

Nerve pain (neuropathic pain) can cause unpleasant sensations on the skin, down the spine, in the eyes and around the chest. The sensations may feel like pins and needles, numbness, burning and stabbing. Sometimes they can feel very painful. Nerve pain is a common MS symptom.

This page covers what these sensations can feel like, why they happen, treatment options and self-management approaches to reduce their impact on your life.

There are various types of nerve pain that can be experienced in different ways.

• Altered sensations (sometimes called dysaesthesia or paraesthesia) – these can be described in various ways such as pins and needles, burning, numbness, prickling, itching and crawling.
• Trigeminal neuralgia – an intense painful sensation in the side of the face.
• Lhermitte's sign – electric shock feelings in the neck and spine which are sometimes painful.
• Optic neuritis – a sharp, knife-like pain behind the eyes that can also cause difficulties with vision.
• MS hug (banding or girdling) – sensations in the chest like pressure, tightness, aching or stabbing, although it can be around the hands, feet, legs or head. (This sensation is not always due to nerve pain. It can also be caused by spasms in the muscles between the ribs.)

Nerve pain in MS can feel very odd and be difficult to explain. Read our information on how to describe your pain

Nerve pain happens because of MS damage to the covering of nerves (myelin) in the brain and spinal cord.

This damage interferes with the normal delivery of messages to the brain. The brain can get confused and misinterpret the messages it's receiving. This may lead to it interpreting the messages incorrectly as pain or unusual feelings like numbness, pins and needles, crawling or burning. These feelings can occur anywhere in your body.

Although the pain may feel like it is in a part of your body, such as your fingertips, there is no damage to the tissues in your hand. The only damage is in the nerves which report to your brain about your hand. This is what makes it seem like there is something wrong with your fingertips.

Nerve pain can happen as part of a relapse. It can also linger on after a relapse if the nerve covering cannot fully repair itself.

Not all nerve pain will be treated. Whether the pain is treated depends on factors such as how bad it is, how long it lasts and how much it is impacting you every day.

Sometimes pain may go away on its own. For example, if it's part of a relapse, the pain may gradually improve as your body recovers. Or if your pain is being triggered by something like heat, it should go away once your body has returned to its normal temperature.

If your pain doesn't go away, there are things you can do to help manage the pain yourself.

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

There are drug treatments you can get to help with nerve pain. Rehabilitation therapies can be useful too.

Common painkillers, like paracetamol and ibuprofen, are not effective at treating nerve pain. This is because they target inflammation and do not treat what is causing the pain (faulty nerves that are sending incorrect pain messages).

Instead, drugs for depression, anxiety and epilepsy are used. Research shows these drugs can reduce nerve pain. It's not fully understood how these drugs work. However, it's thought they may interfere with the delivery of pain messages to the brain, reducing the amount of pain you feel.

Your MS team or GP may recommend one of these drugs first to treat your nerve pain.

• Amitriptyline – an antidepressant that's commonly used to treat low mood and depression. It's used in lower doses to treat nerve pain. It's usually suggested that you take it at night as it can make you feel sleepy. It can take a few weeks before you notice the effect of this drug.
• Duloxetine – an antidepressant that's used for depression and anxiety, as well as nerve pain. It can take at least a few weeks before you start to notice it working. Read more about duloxetine (NHS.UK)
• Gabapentin – an anti-seizure drug that's used in epilepsy but is also used to treat nerve pain.
• Pregabalin – a drug that's used to treat epilepsy and anxiety, as well as nerve pain.

You will usually be started with a low dose which is built up slowly until an effective dose is reached.

You will usually take these drugs as tablets, capsules or a liquid.

If you try one of these drugs and they do not work effectively, or you're struggling with side effects, your MS team or GP may suggest switching to one of the other drugs instead. It can take some trial and error to find what works best for you. Your treatment should be regularly reviewed by a health professional to check the drug is working well and you're not experiencing any unwanted side effects.

Many side effects wear off or steps can be taken to manage them. For example, if a medication makes you sleepy, it may be best to take it last thing at night. This may also be helpful if pain has been disrupting your sleep.

Sometimes the side effects of nerve pain medications can outweigh the benefits, so you may prefer to manage your pain through self-management approaches.

Do consult with a health professional before stopping any of these treatments, as you may need to stop them gradually to avoid withdrawal symptoms.

If your pain is part of a relapse, where your symptoms flare up, then you may be offered steroids. Steroids help to speed up your recovery from a relapse.

Trigeminal neuralgia is treated slightly differently. Your MS team or GP may suggest an anti-epileptic drug called carbamazepine. There are also surgical options to treat this type of nerve pain. Read more about treatments for trigeminal neuralgia

Although nerve pain can usually be improved with medication, these drugs cannot always get rid of the pain completely. So, it's often best to take other steps to manage your nerve pain alongside drug treatments.

An occupational therapist (OT) can suggest aids and equipment that might help you with daily activities if nerve pain is making things difficult. For example, if numbness in your hands and fingers is affecting activities like picking up objects or writing, they may suggest a different way of doing these things or recommend equipment to help. OTs may also suggest lifestyle changes to make things easier for you and help relieve your pain. 

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 for temporary pain relief. TENS may work for pain that is burning, tingling or shooting in nature.

You can hire or buy 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 nerve 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.

Learning coping strategies or making changes to everyday life can help reduce the impact of nerve pain on you.

These self-help, or self-management, approaches can make a big difference. This can include things like pacing yourself, noticing what triggers your pain and using techniques to relax or distract yourself.

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 try a few options at once for the best effect.

Research shows that a healthy lifestyle can reduce pain. Keeping active can also improve your mood, helping you to cope better with pain.

Being more active doesn't have to involve vigorous exercise. It could be more 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 exercise 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 makes your pain worse.

Explore our range of accessible exercise resources

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 day-to-day activities/tasks into smaller chunks and taking regular, short breaks. 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.

Being aware of things that trigger your nerve pain, or make it worse, can be very useful when it comes to managing pain. If you know your triggers, you may be able to avoid them or reduce them. For example, avoiding hot showers or taking steps to reduce your stress levels. This may stop the nerve pain being triggered in the first place or ease the pain to a more manageable level.

Here are some things that may trigger nerve pain.

• Temperature sensitivity such as being too hot or too cold. Try to keep yourself and your environment at a comfortable temperature.
• Illness and infections. Take time to rest and ensure any infections are treated promptly as per your doctor's advice.
• Being stressed. You may not be able to get rid of stress completely, but you can take steps to reduce and manage stress better.
• Other MS symptoms like fatigue, bladder and bowel problems, and muscle stiffness and spasms. Seek support to ensure they're managed as well as possible.

Keeping a diary of when your pain feels better or worse can help you to spot these triggers.

There is some evidence that complementary therapies, such as reflexology and acupuncture, can help with pain in MS.

Read more about complementary therapies you could try.

Nerve 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, 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.

Relaxation techniques can also help reduce stress if this is a trigger for your pain.

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 if you can 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
• NICE guideline – Neuropathic pain in adults: pharmacological management in non-specialist settings
• 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.