Managing MS Pain and Other Symptoms
A ‘Snowflake’ Disease
MS stands for Multiple Sclerosis. At Unpain Clinic, we treat MS clients on a regular basis. So, we thought we’d shine a spotlight on Multiple Sclerosis and what you can expect from a treatment at Unpain. Canada has one of the highest rates of Multiple Sclerosis (MS) in the world, with an estimated 1 in every 385 Canadians living with the disease. While those most commonly diagnosed tend to be between the ages of 20-49 years, younger children and older adults can be diagnosed as well. MS is often called a “snowflake disease”; because of the long list of possible symptoms of varying severity, not many MS patients are the same.
Science of Sclerosis
Multiple Sclerosis is classified as an autoimmune disease of the central nervous system (the brain and spinal cord). The immune system attacks the myelin (the protective covering of the nerves), causing inflammation and damage, interrupting crucial nerve impulses. Imagine a live electrical wire that has been insulated with rubber coating. The wire is the nerve and the rubberized coating, the myelin. If substantial damage occurs to the myelin sheath and is replaced with scar tissue, nerve impulses may be completely and permanently disrupted, damaging the nerve fibres themselves. This inhibits necessary communication within the body to perform basic functions such as speaking, seeing, walking, and learning.
What is Shockwave Therapy?
Shockwave therapy is a sound wave, evolved from lithotripsy: the same technology used the treat kidney stones. It is one of the most well-researched modalities in regenerative medicine, to date. It works by disrupting and removing any scar tissue, stimulating new blood vessel growth, and driving stem cell migration in the treatment area. As a result, tissue responds with better range of motion due to fewer restrictions and overall improvement in circulation to the tissue. More stem cells, circulation and less scar tissue mean better healing.
The Plight of the MS Patient
MS has many symptoms. As the underlying cause of most symptoms is interference at the nerve pathway, there are multiple outcomes that could be observed. Lack of tone and muscular engagement can even lead to tertiary symptoms such as bed sores due to prolonged sitting. Alternatively, muscle hypertonia (uncontrollable muscle spasms) can also be common and affects up to 80% of subjects with MS; it is often quite painful. The pain can be caused by the prolonged abnormal contractions due to spasticity making them stiff, heavy and difficult to move. It also depends on the musculoskeletal conditions that arise from other complications of MS. Muscle weakness, hypertonia and soft tissue changes disturb body weight distribution, inducing excessive stress on joint structures and causing pain. Sensory disturbances can also play a role. It is the mixing and matching of these components that leads to the pain perceived by patients with MS. The reciprocal relationship between spasticity and pain is amplified by the fact that pain increases spasticity, setting the course for a disabling pain-spasticity cycle.
Shockwave Can Help Break the Pain – Spasticity – Pain Cycle
The application of shockwave in musculoskeletal disorders has been widely and successfully used in the treatment of pain in various complex conditions, including MS. Studies using shockwave on pain reduction observed that success was largely the result of the shockwave’s action on nociception (the perception of pain). Although pain relief is the main result reported following treatment, the antinociceptive mechanisms of shockwaves are far from being completely understood. Important cellular mechanisms are thought to be nitric oxide production vital for excellent blood flow and the reduction of inflammation and pain reception. Another mechanism could be the effect of shockwave on muscle fibrosis and other non-reflex components of muscle hypertonia. This mechanism has been originally suggested to explain the reduction of muscle tone induced by shockwave therapy treatment. Through its action on non-reflex hypertonia, even radial pressure wave has shown as a promising treatment for spasticity. The reduced muscle extensibility of MS patients due to scar tissue causes pulling forces to be transmitted more readily to the muscle spindles. In this condition, an exaggerated spindle discharge in response to muscle stretch might lead to increased muscle contractions.
Patient Experience
A study of MS patients with hypertonia of ankle extensor muscles associated with pain, concluded that 4 sessions of shockwave therapy induced a significant pain reduction. This effect, peaking 1 week after the final session. After shockwave, no adverse effects were observed in any patient. Hypertonicity decreased one week after final sessions and pain was decreased by 65% to 91%, and the complications were low and negligible at all follow-up evaluations.
Patient Experience
A study of MS patients with hypertonia of ankle extensor muscles associated with pain, concluded that 4 sessions of shockwave therapy induced a significant pain reduction. This effect, peaking 1 week after the final session. After shockwave, no adverse effects were observed in any patient. Hypertonicity decreased one week after final sessions and pain was decreased by 65% to 91%, and the complications were low and negligible at all follow-up evaluations.
Some MS patients receiving Interferon β or glatiramer acetate injections can experience
Injection Panniculitis, which presents as painful or tender bumps that form in the layer of
fat under your skin. Shockwave used at injection sites showed significant pain reduction
and reduction of skin induration.
Long-Term Outlook
To optimise the effect in MS patients and obtain functional results, shockwave therapy should be integrated into a rehabilitation program, where physiotherapy should consist of active and passive stretching of the hypertonic muscles, strength training of the affected muscles, functional mobility training and gait pattern training. Physiotherapy, shockwave therapy, occupational therapy, and speech therapy can help you manage some physical problems caused by MS. You can also help yourself at home by eating balanced meals, getting regular exercise and rest, and learning to use your energy wisely.
A Final Word
MS is a permanent condition. The pain and symptoms associated with MS do not have to be. Many MS clients visit our clinic facing surgeries, severely restricted mobility or chronic pain. They go on to live life with fewer symptoms and less pain. Many avoid surgeries altogether and are able leaving their mobility aids behind them. Shockwave may not be a cure-all, but it is certainly a highly effective approach when managing pain in MS clients on a relatively long-term basis, with little need for surgeries or medications.
Citations
1) Stieger M, Schmid J, -P, Yawalkar N, Hunziker T: Extracorporeal Shock Wave Therapy for Injection Site Panniculitis in Multiple Sclerosis Patients. Dermatology 2015;230:82-86. doi: 10.1159/000368351
2) Lohse-Busch H, Kraemer M and Reime U. [A pilot investigation into the effects of extracorporeal shock waves on muscular dysfunction in children with spastic movement disorders]. Schmerz 1997; 11: 108-112
3) Marinelli, L., Mori, L., Solaro, C., Uccelli, A., Pelosin, E., Currà, A., … Trompetto, C. (2015). Effect of radial shock wave therapy on pain and muscle hypertonia: a double-blind study in patients with multiple sclerosis. Multiple Sclerosis Journal, 21(5), 622–629. https://doi.org/10.1177/1352458514549566
4) Schaden W, et al: Shock wave therapy for acute and chronic soft tissue wounds: a feasibility study. J Surg Res 2007;143:1-12.
5) Almeida, L.M., Requena, L., Kutzner, H., Angulo, J.G., Sa, J.D., & Pignatelli, J.G. (2006). Localized panniculitis secondary to subcutaneous glatiramer acetate injections for the treatment of multiple sclerosis: a clinicopathologic and immunohistochemical study. Journal of the American Academy of Dermatology, 55 6, 968-74 .
6) Wang C. J. (2012). Extracorporeal shockwave therapy in musculoskeletal disorders. Journal of orthopaedic surgery and research, 7, 11. doi:10.1186/1749-799X-7-11