Multiple sclerosis (MS) is often associated with nerve-related pain, but a significant and frequently overlooked issue is musculoskeletal (MSK) pain – discomfort arising from the body’s altered mechanics, weakness, and spasticity. This type of pain affects muscles, joints, and connective tissues and can severely impact quality of life.
Why MSK Pain Matters
MS doesn’t just affect the nervous system; it fundamentally changes how the body moves and supports itself. As the disease progresses, imbalances develop, leading to abnormal stress on muscles and joints. This isn’t simply “wear and tear”; it’s a direct consequence of MS-related changes. Ignoring this pain can lead to chronic discomfort, reduced mobility, and further complications.
How Does MSK Pain Feel?
Unlike the burning or tingling sensations of nerve pain, MSK pain presents as dull aches, stiffness, throbbing, or tenderness in areas like the neck, shoulders, back, and limbs. It often worsens with inactivity, unusual movements, or prolonged positions. People with MS frequently describe it as similar to overuse pain from intense exercise—except it happens with everyday activities.
Key areas affected include:
– Neck and shoulder stiffness
– Joint pain in weight-bearing areas (knees, hips)
– Localized lower back discomfort after activity
The Root Causes of MSK Pain
Several MS-related factors contribute to MSK pain:
- Fatigue: Alters movement patterns, increasing strain.
- Muscle Weakness: Forces other muscles to overcompensate, leading to overuse.
- Balance Problems: Causes awkward gait adjustments that stress joints.
- Mobility Challenges: Leads to inactivity, muscle atrophy, and increased pain.
- Drop Foot: Unnatural walking patterns strain hips, thighs, and lower back.
- Chronic Spasticity: Tight muscles redistribute weight incorrectly, causing joint stress.
- Falls: Common in MS, these can result in injuries that don’t always present immediately.
Diagnosing MSK Pain Effectively
Proper diagnosis is crucial, as MS presents multiple pain types. A healthcare provider will:
- Detailed questioning: To understand the pain’s exact nature.
- Physical examination: Assessing posture, gait, strength, and flexibility.
- Palpation: Gently pressing on sore muscles and joints.
- Activity assessment: Reviewing daily activities, falls, and functional limitations.
Imaging (MRI or EMG) may be used to rule out other conditions. The goal is to distinguish MSK pain from nerve or inflammatory pain, as treatment approaches differ.
The Interplay of Fatigue, Mood, and Pain
Fatigue, anxiety, and depression are common in MS and can amplify pain perception. This creates a vicious cycle: pain limits mobility, inactivity worsens fatigue, and mood issues heighten sensitivity. Breaking this cycle requires a holistic approach:
- Restorative sleep
- Gradual conditioning
- Psychological support
Mindful Movement and Expert Care
Moving with awareness is key. Pacing activities, using assistive devices, and practicing regular mobility exercises help maintain function. Early intervention is best; seeking expert care soon after diagnosis can prevent pain from escalating.
Musculoskeletal pain is a prevalent but often underestimated aspect of MS. Recognizing its causes, symptoms, and the importance of proactive management is vital for improving quality of life.
Sources:
ShayestehAzar M et al. A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple Sclerosis Patients; a Cross-Sectional Study. The Archives of Bone and Joint Surgery. April 2015.
Understanding and Managing Pain in Multiple Sclerosis. Cleveland Clinic.
Pain and MS. MS Society. October 1, 2025.
Foot Drop. MS Trust.
Coote S et al. Falls in People with Multiple Sclerosis. International Journal of MS Care. September 14, 2020.
De la Corte-Rodriguez H et al. The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best medicine — A Narrative Review. Healthcare (Basel). January 18, 2024.
Johnson MA et al. Complementary and Alternative Medicine for Chronic Musculoskeletal Pain. Federal Practitioner. September 2015.
