Managing MS often involves two different approaches:
- symptomatic treatments – to manage the individual symptoms of MS
- disease modifying drugs – to treat the underlying condition.
This section focuses on the different options for treating MS symptoms.
Learning to manage your symptoms takes time and you may need to try several options to find out what works best for you. Reading up about the different options can be helpful, so you can talk them through with your GP or MS team.
Treatment for MS may include medication, therapies, such as physiotherapy, and self-management techniques. Some people explore the use of complementary or alternative medicines (CAMs).
There are also disease modifying drugs (known as DMDs or DMTs) which can reduce the number and impact of relapses and reduce the build-up of disability which can occur if you don't recover completely from relapses. Most DMDs are for people with relapsing remitting MS (RRMS), but there are some that are licenced for use by people with progressive MS. MS Decisions, our interactive decision aid can help if you are considering a DMD.
What are symptomatic treatments?
Symptomatic treatments help relieve the physical or mental symptoms of a condition. They don't treat the underlying cause, or change the course of the condition. There's a wide range of treatments which are used to manage MS symptoms, they include:
There's a wide range of possible treatments so we will point you to the relevant resources for more detailed information. You may prefer to focus on information about the symptoms that are troubling you now. It can be a bit overwhelming to read about all the possible symptoms of MS. Not everyone experiences all of them so you might like to leave aside information that is not relevant to you.
You'll find information on the treatment of specific symptoms in the A-Z of MS. For some symptoms, we have in depth, free publications which can be ordered or downloaded from the shop.
What are my treatment options?
Treatments are available for the symptoms of MS regardless of whether you have relapsing remitting MS or progressive MS. Often people with progressive MS are under the impression that there aren't any treatments for them.
Your options will depend on what symptoms you're experiencing, how much they're affecting your day-to-day life and sometimes what specialist services are available in your area.
In this section you'll find a brief overview of some of the typical symptoms seen in MS and the most common conventional approaches to their treatment. This might include drug treatments, therapies, rehabilitation strategies or management techniques.
Learning strategies such as focusing on the tasks which are most important to you and how to carry them out in the most efficient way, can be helpful. These can be taught by a physiotherapist and/or occupational therapist. The drug treatment amantadine (Symmetrel) helps some people with mild to moderate fatigue, but medication usually isn't a solution on its own and is usually combined with techniques such as pacing, prioritising and breaking down tasks.
Treatment depends on the type of pain. Muscular or joint pain can be treated with painkillers such as paracetamol or ibuprofen. The drugs used for nerve pain include amitriptyline (Triptafen), gabapentin (Neurontin) and pregabalin (Lyrica). Physiotherapy can help some pain. Often the best results are seen with a combination of drug treatment and physiotherapy.
Treatment varies depending on the issue. Occasionally, steroids are used for optic neuritis. For double vision, patches or prisms on glasses are tried first, but botulinum toxin (Botox) may be used in more severe cases. Gabapentin may be prescribed for persistent nystagmus to reduce the twitches.
There aren't any drug treatments which are routinely used for memory and thinking problems in MS. A neuropsychologist, speech and language therapist or occupational therapist can teach you compensatory strategies to help work around your issues, this is known as cognitive rehabilitation therapy.
If you have problems with storing urine, such as needing to go to the toilet urgently or frequently, there are medicines that can help such as oxybutynin (Ditropan, Lyrinel XL) or tolterodine (Detrusitol). Bladder training with the support of a continence specialist can help you increase the length of time between toilet trips. In more severe cases, where standard drugs haven't helped, botulinum toxin may be injected into the bladder wall. Another option to reduce symptoms of an overactive bladder, if you don't want to try botulinum toxin, is nerve stimulation.
If you have problems emptying your bladder (hesitancy) one option is to try using a catheter. A bladder scan after you've been to the toilet can help establish if your bladder is emptying completely. Holding a vibrating device over the pubic area can help relax the valve at the base of the bladder to improve emptying.
If you are constipated, there are a variety of laxatives or stool softeners that can be tried, such as ispaghula (Fybogel), lactulose (Lactugal) and docusate (Docusol). Some people find that abdominal massage can help with constipation, this can be taught by a continence advisor.
If you have trouble controlling when your bowels open, a physiotherapist or continence advisor can suggest exercises to strengthen the muscles around your anus. There are also products available if bowel accidents are an issue. Some specialist centres offer biofeedback training where you're given help to retrain your bowel, advice on dietary changes that could help and psychological support.
Drug treatments which can be tried include baclofen, carbamazepine (Tegretol), gabapentin and botulinum toxin. Occupational therapists and physiotherapists can also offer support to help manage spasticity, this might include stretching exercises or advice on posture/positioning when you're sitting down or lying in bed, to make you more comfortable.
Can occur in men and women. If MS causes erectile dysfunction, treatments such as sildenafil citrate (Viagra) and tadalafil (Cialis) are available. Talking therapies can be a good option if you're experiencing difficulties such as loss of desire, changes in sensation or you're struggling with self-esteem.
A physiotherapist or occupational therapist can support you with walking difficulties. The drug fampridine (Fampyra) has been shown to increase walking speed in some people with MS, regrettably it's not always available through the NHS. If you experience foot drop you may find that functional electrical stimulation (FES) helps, although availability is patchy both on the NHS and privately.
You may have noticed that drugs often have more than one name. All drugs have a generic name, which is the official medical name for the active ingredient in the drug. They may also have a brand name, the trade name given by the manufacturer. Brand names always begin with a capital letter, whereas generic names don't.
Sometimes a drug is more commonly known by its generic name, for example gabapentin used for neuropathic pain; whilst others are better known by their brand name, like Viagra for erectile dysfunction. If a drug is produced by more than one manufacturer there can be more than one brand name for the same medication.
Paying for symptomatic treatments
In England, people with MS have to pay prescription charges for symptomatic treatments, unless you qualify for free prescriptions for another reason. Prepayment certificates are available which can save you money if you require several medications regularly.
There are no prescription charges in Scotland, Wales and Northern Ireland.
Complementary and alternative approaches
Complementary and alternative approaches (CAMs) are often talked about as being the same thing, but there is a distinction between the two.
A treatment is said to be 'complementary' when a non-mainstream approach is used alongside conventional medicine. An example would be having acupuncture sessions alongside taking prescription medication for pain.
If the non-mainstream approach is taken instead of a conventional approach, then the treatment would be considered 'alternative'. An example of this would be taking a homeopathic medicine rather than a conventional drug treatment.
There is of course some degree of overlap and many treatments can sit in both categories, for example osteopathy (the manipulation, stretching and massage of your muscles and joints) is used as a complementary treatment in some situations, but may be used on its own as an alternative therapy in others.
The following are a few of the complementary and alternative approaches that are commonly used in MS.
Several diets have been advocated as being beneficial for MS, but none have been shown to work for everyone. Following a healthy diet benefits everyone, but it can be especially important in MS.
Maintaining a healthy weight can help with symptoms, such as fatigue and pain, by maintaining energy levels and avoiding putting excess weight on joints. Ensuring you’re getting enough fluid and fibre in your diet can help combat bladder and bowel issues. It’s also essential to help maintain a healthy heart as high blood pressure and heart disease can also impact on MS.
There’s lots of evidence that exercise can help with MS symptoms and benefit both your physical and mental wellbeing. This might be something gentle like yoga, Pilates or Tai Chi which focus on flexibility, strength and balance; or it may be something more energetic or cardiovascular-based such as swimming, running or dancing. Exercise can help you maintain a healthy weight, improve mobility and also give your mental health a boost.
Practices such as breathing exercises, meditation or mindfulness can be helpful if you’re feeling under pressure or experiencing anxiety, low mood or depression. They can also be a distraction from symptoms such as pain and spasticity. Aromatherapy, reflexology and massage may also help.
If you’re considering using CAM approaches, as well as considering the potential benefits, it’s important to think about both the potential costs involved and any possible risks. Some alternative medicines can interact with prescription medicines. A well known example of this is St John’s wort which some people use for depression – it can cause problems if used with some prescription depression medication and also reduces the effectiveness of contraceptive pills. Alternative medicines typically shouldn’t be used if you’re pregnant. It’s best to have a discussion with a health professional if you’re considering trying a CAM.
When should I seek treatment?
It can be difficult to know when to seek treatment and when to sit things out, especially if you're still learning about your MS. There are a few things you can look out for which may explain why your symptoms are worse at the moment.
- Do you have an infection such as a cold, flu, tummy bug or a bladder infection? If so, this can cause a flare up of symptoms. Your symptoms will improve as you recover from the infection so you should look after yourself in the usual way for a cold, flu or tummy bug, or visit your GP or MS nurse to see if you need antibiotics for a bladder infection.
- Are you too hot? Many people with MS are sensitive to heat. You may find that hot weather makes your symptoms worse and the same can happen if the central heating is too high. Do what you can to get cool and symptoms should improve.
- Are you too cold? Some people find that being too cold makes their symptoms flare up although this is not as common as heat sensitivity.
- Are you feeling under pressure? Stress can make your symptoms harder to live with and, for this reason, finding a technique that makes you feel more in control can be helpful.
When to seek support from a health professional is a personal decision. However, if none of the above apply, or your symptoms don't improve after a few days, you might want to consider getting support from your GP or MS team.
- If you have new symptoms, your symptoms are suddenly much worse, or if you are having serious difficulty walking it's probably worth contacting your MS nurse straight away – especially if you experience relapses.
- Sometimes symptoms creep up on you and suddenly a slow, gradual worsening over months or years might add up to a big change you can't ignore. You should have your MS reviewed about once a year but, if this isn't happening or your appointment is a long way off, you can ask for a review.
- If your symptoms are worrying you, interfering with your quality of life, or impacting negatively on family or friends – don't suffer in silence.
Remember, new symptoms may not be due to MS, so speak to your GP or MS team if you're concerned. Also, make sure you keep up with any vaccinations, or health screening for conditions such as diabetes, high blood pressure or cancer, where appropriate.
Which health professionals will support me?
Although you will be in charge of managing many aspects of your MS, like taking medication as prescribed or keeping up with exercises recommended by a physiotherapist, sometimes you might need a bit of extra support to make sure you’re on top of your symptoms, you’ve selected the best treatment option for you, or if things change.
MS services work differently in different areas, so it's a good idea to check with your team in advance who to contact, and how, if you're concerned about symptoms. Your symptoms may be reviewed by your neurologist, your MS nurse, or you may be referred to someone who specialises in a particular therapy such as a physiotherapist or speech and language therapist, or someone who specialises in the management of a particular symptom, for example a pain specialist, continence nurse or a spasticity nurse. Your GP can help with some symptoms or refer you to other services if you need them.
What if the treatment isn't helping?
Many treatments don’t start working immediately, it may take a few weeks or months before you see any benefit. Hopefully you’ll be given an idea of when you might expect to see results or be offered an appointment to review how you’re doing after an appropriate time.
For some medicines, the dose might have to be increased gradually until you find the best possible relief for you. Typically you’d start on a low dose and be advised when to increase the dose and by how much, or have a review before any changes are made.
Not all treatments work for everyone, so if the treatment really isn’t working, ask if there’s an alternative you can try. Sometimes it can be a case of trying several options, or a combination of treatments, to find what works best for you.
Unfortunately, sometimes treatments don’t get rid of symptoms completely. For instance, treatments for nerve pain may reduce the pain to a more manageable level, but you may still experience some pain in the background. The same is also true for fatigue.
Are there new or experimental treatments I should consider?
There is no cure for MS, so beware of anyone claiming they’re offering a cure. The most important thing is to use reliable sources of information to inform your decisions, such as the MS Trust. Other sources may sound convincing but they may just be opinion, marketing hype or personal experience presented as facts.
If you do find a treatment that interests you, do your research. If there’s been a genuine breakthrough, the main MS charities will be reporting it too. Look for different opinions on the research and consider what is being said. Often research reported in the press is at an early stage, so it might be a while before a treatment becomes widely available or it may never get to that point at all.
It can be tempting to try an experimental or controversial treatment, but you need to consider the risks of harm, potentially significant side effects and the costs involved. If in doubt, have a chat with your MS team or GP.
How do I find out about new treatments?
MS is a very active area of research and new treatments are coming through all the time. Keep asking if there are any new options during appointments with your MS team, especially if you feel your symptoms aren't being managed as well as you'd like.
It's worth keeping an eye on our news & stories pages or read the latest research to stay up to date.