“For example, some back pain in MS can be traced back to a lesion in the spinal cord. Headache, facial pain, and extremity pain can also be linked back to a lesion in the central nervous system,” says Fiol. Musculoskeletal pain can occur as a result of changes that the disease causes to the body overall.
Neck and back pain: Some people with MS can experience neck and back pain. This may be due to immobility, or to the same type of wear and tear that many people without MS experience. This type of pain is often an aching, stiff sensation that can be moderately severe.
MS breaks down the layer of myelin and leaves patients with unprotected nerves that do not work as well as they should. As a result, patients may experience a number of uncomfortable symptoms, including spine pain.
MS lesions on the cervical spine can cause similar symptoms to when they appear in other areas, such as numbness, weakness, and balance issues. In addition, they can cause loss of sensation in both the shoulders and arms. For some, lesions on the cervical spine can lead to paralysis in all limbs.
Lhermitte's sign is another common symptom of MS. It is a short, intense pain that runs from the back of the head down the spine and sometimes into the arms or legs.
MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.
Magnetic resonance imaging, or MRI, is a wonderful tool to help diagnose and follow people with MS. MRI is safe and relatively non-invasive yet can provide very detailed images of the brain and spinal cord that can reveal MS lesions (also known as demyelination, spots, or plaques) and changes in MS activity over time.
What do MS lesions feel like? Even though the central nervous system is packed with nerve cells, the brain tissue itself does not have so-called noniceptors — the sensory nerve fibers that detect pain and potentially damaging stimuli. Thus, MS lesions themselves cannot be felt.
Multiple sclerosis lesions can occur in any portion of the cerebellar white matter and peduncles, frequently involving the middle and superior cerebellar peduncles (Fig. 3). However, prominent involvement of this region is also seen in anti-MOG-IgG disease and progressive multifocal leukoencephalopathy.
An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.
Tightness or stiffness of the muscles, called spasticity, is caused directly by MS. Spasticity, will alter walking and cause pulling on the joints. This can result in pain typically in the ankles, knees, hips and back.
But the brain isn't the only area where lesions can develop — MS can also attack the spinal cord. Because finding these lesions involves more elaborate imaging tests, spinal cord lesions in MS are studied less often, and many people with MS aren't aware of the role these lesions may play in the disease process.
Spinal cord lesions are common in MS. They're found in about 80 percent of people newly diagnosed with MS. Sometimes the number of spinal lesions identified from an MRI can provide the doctor with an idea of the severity of the MS and the likelihood of a more serious episode of demyelination occurring in the future.
Spinal Disorders
This irritation of nearby nerves can lead to numbness or weakness in the area of the body that correlates with the affected nerves. These symptoms can mimic those of MS.
The 'MS hug' is symptom of MS that feels like an uncomfortable, sometimes painful feeling of tightness or pressure, usually around your stomach or chest. The pain or tightness can stretch all around the chest or stomach, or it can be just on one side.
The takeaway. It's easy to mistake sciatica as a symptom or related condition of MS, which often causes neuropathic pain. But while the two do coexist, sciatica isn't caused by MS. It's caused by strain on the sciatic nerve.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
These attacks or relapses of MS typically reach their peak within a few days at most and then resolve slowly over the next several days or weeks so that a typical relapse will be symptomatic for about eight weeks from onset to recovery.
Even without medical treatment, brain lesions in MS don't simply keep growing and growing. “The body calms down these lesions and surrounds them, and they stop,” says Cross.
In MS (a), MRI shows areas of T2 hyperintensity which extend for a single vertebral level, involve both grey and white matter in the lateral-posterior part of the cord and have a cylindric shape on the sagittal view and a wedge shape on the axial view.
New lesions might occur in patients with progressive MS and adjusting therapy can be considered. Patients with untreated CIS should be scanned every 1–3 months for the initial 6 months and if stable repeating MRIs every 6–12 months is recommended, unless new clinical symptoms occur.
Spinal MS occurs more commonly with lesions in the cervical spine (the neck area) in approximately 67 percent of cases. Lesions in this area often affect the corticospinal tract. Neurological signs which indicate lesions in the corticospinal tract include the Babinski Sign and the Hoffmann Sign.
People should consider the diagnosis of MS if they have one or more of these symptoms: vision loss in one or both eyes. acute paralysis in the legs or along one side of the body. acute numbness and tingling in a limb.
A wide range of conditions can be mistaken for MS, including: migraine, cerebral small vessel disease, fibromyalgia, functional neurological disorders, and neuromyelitis optica spectrum disorders, along with uncommon inflammatory, infectious and metabolic conditions (1, 3).