MS hug

The MS hug is a common symptom of multiple sclerosis (MS). It is a type of pain that feels like a tight, squeezing sensation around your chest, ribs or stomach. Sometimes it only affects one side of the body. Some people find it can make it painful to breathe.

On this page we describe what the MS hug is, what it feels like and why it happens. The page also looks at tips and treatments that can help reduce the impact of the MS hug.

The MS hug is also known as banding or girdling. It is a type of MS pain that can be felt anywhere between the neck and waist. The MS hug may only cause mild discomfort, but it can sometimes be very painful. It can also feel so tight that it’s uncomfortable to breathe.

It can feel like a tight uncomfortable band or squeezing around your chest, ribs or stomach. The MS hug can also cause feelings of pressure, aching, burning or tingling sensations. 

Some people experience a symptom similar to the MS hug but in their hands or feet. It can feel as though you’re constantly wearing tight-fitting gloves or boots. For others, the squeezing sensation may be felt around the head. 

The feeling is different for everyone. It may be a sharp or dull pain. It can be short-lived lasting for a few seconds or be more long-lasting pain over hours or even days.

There are two reasons why the MS hug can happen.

The MS hug can happen if MS nerve damage disrupts messages travelling along the sensory nerve pathways to the brain. This can lead to a type of nerve pain known as altered sensations. The brain doesn’t know how to interpret these disrupted messages. So, it tries to relate it to a familiar sensation such as aching, tingling, burning or tightness.

MS damage can also interrupt the nerve signals that control how much tension is in your muscles and how much they tighten and relax. If the tension increases too much the muscles can spasm. The small muscles between your ribs (intercostal muscles) help expand your chest when breathing. If they go into spasm it can lead to the feeling of tightness in the chest. It can also feel like it is more difficult to breathe.

People with MS often say they find that the MS hug feels worse, or flares up, when they’re feeling fatigued, stressed or have an increase in their body temperature, for example due to an infection or hot weather.

The MS hug can happen as part of a relapse. If other MS symptoms have come on suddenly at the same time, it may be a relapse. If this is the case, it is best to contact your MS team as soon as possible so they can confirm if you’re having a relapse. Once your MS nurse has confirmed that you’re having a relapse, they should discuss your symptoms with you and decide whether you need treatment for the relapse itself or any of the symptoms you’re experiencing. 

The MS hug is quite a common symptom of MS, but it’s not well known, especially if you have just been diagnosed. It can be quite scary if the MS hug sensations suddenly appear from nowhere. The MS hug is not dangerous, but it can mimic other heart and lung problems. Any chest pain should always be taken seriously in case it needs immediate medical attention.

If you’ve not experienced chest pain before, or it is severe, accompanied by breathing difficulties, sweating or feeling sick it is best to get checked by a doctor straight away at the accident and emergency (A&E) department of your nearest hospital.

If you have already been diagnosed with the MS hug and the symptoms haven’t changed, you’re unlikely to need urgent medical attention. But if the sensations are different or become more severe, do not assume that what you’re experiencing is part of your MS. Seek advice. Your MS team may be available at short notice, but it may be quicker to see your GP. If the pain is very severe or you’re having difficulty breathing it is better to go directly to A&E.

As the MS hug feels different to each person, it is helpful to describe what you’re experiencing in as much detail as possible when talking with health professionals. Then they are more likely to understand what it feels like for you and the effect it is having on your everyday life. Think about the following.

• Does the pain come in short or long bursts, or is it there all the time?
• Is it sharp or dull?
• Does it feel painful, aching, burning or tight? Or is it some other sensation? Can you describe it even if it seems odd?
• Did it start suddenly or gradually increase over time?
• Did it start at the same time as other new symptoms?
• Has it happened before? When? Does it feel the same?
• Is it stopping you doing what you’d like to do? Is it affecting your sleep, work or ability to move freely? For example, it takes you two hours to get to sleep, or you can only sit still for short periods of time.
• Is there anything that helps ease the pain?

Although uncomfortable, the MS hug often passes without needing treatment. There are things you can do which may help relieve the sensations. However, if the MS hug lasts for a long time or is very painful, there are medicines available which may help you.

There are many simple things you can try to see if it helps ease the pain. You might need to try a few of the options suggested below to find what works best for you. It could be that a combination of a few of the approaches will give the best effect.

Try to identify and avoid any triggers if you can. Keeping track of when MS hug symptoms flare up and if there are any particular triggers such as stress, fatigue, illness or extreme temperature changes can help you try and minimise their effect.

If you find tight clothing triggers or worsens your MS hug, try wearing looser, lightweight clothing in soft breathable fabrics, such as cotton or linen, to see if that helps. Some people find not wearing items such as underwired bras can help if the situation allows.

For others, wearing tighter clothing can actually help. A close-fitting top, or a scarf or bandage wrapped around the chest can provide the brain with a logical reason for the tightness and take its focus away from the sensation.

If it is your hands, feet or legs that are affected you could try wearing gloves, socks or boots on the affected body part. A hat may help with any tightness felt around the head.

Some people find that wearing compression garments or simply applying pressure to the area with the flat of the hand helps.

Gentle stretching exercises, yoga or Pilates may help to reduce any tightness. Simply changing position may also help. It may be that the sensation feels better if you sit up straight or lie down.

Breathing exercises, especially those that focus on slow, deep breaths can help relax your muscles. Deep breathing can also distract you from the pain and reduce any anxiety by helping you focus on staying calm and relaxed.

Relaxation techniques such as mindfulness and meditation can also distract you by taking your attention away from the pain.

Warm baths or using hot compresses on the area can help relax the muscles. Other people find a cold compress such as an icepack works better than heat. Do take care though if you have reduced sensitivity to temperature to ensure you don’t damage your skin.

Techniques such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT), can be helpful if living with the MS hug is having an emotional impact or affecting your mental health.

Many of the ways to manage other types of pain can also help with the MS hug.

If you find none of these options help, or if your MS hug is happening more frequently or the pain is becoming more severe, talk to your GP or MS team. This could be a sign that you’re having a relapse or that it is the right time to explore the medical treatments for help.

Often your neurologist and MS nurse will work with you to manage your MS hug symptoms. In some parts of the UK, you may be referred to a pain clinic with its own specialist team of doctors and nurses.

The medical treatments that can help with the MS hug depend on whether the sensations are due to nerve pain or muscle spasms. 

The treatment options are the same as for other types of nerve pain and altered sensations. Antidepressants such as amitriptyline or duloxetine, or the anticonvulsants gabapentin or pregabalin are usually recommended first.

Drugs that are used to manage spasticity, which relax muscles, will be offered if the pain is due to spasms of the intercostal muscles. Usually, the first drug that will be tried is baclofen.  If this does not work, gabapentin will be tried next. 

There are other treatment options for nerve pain and muscle spasms if the above medications don’t provide enough relief.

If you’re already taking nerve pain or spasticity medication and still experiencing the MS hug, it could indicate that you need to adjust your current dose or try something different. If the MS hug is part of a relapse, then steroids may also be considered. 

Your MS team should review your treatment regularly and suggest alternatives if something is not working well. Sometimes a combination of drugs works best.

• What is the MS hug? - a blog post about dealing with the MS Hug

• Pain - our comprehensive page on pain in MS