Fran: What can MSers do for general pain management?
Dr Bernhard Frank, Pain consultant: Again, like in the question before, it depends a bit what type of pain, you know, you suffer from. And like I said, for the neuropathic pain there are kind of guidelines in terms of medication, you know, what you should try in a systematic way and I always suggest, because of the other problems in MS, with fatigue, whatever, that you really need to declare what you want to achieve with these drugs, then stop the drugs again when they don’t cause pain relief because they normally have side effects which will make other symptoms, like fatigue, for example, worse. If it’s more musculoskeletal pain, you know, then I think physiotherapy and things like a pain management programme where you learn to cope with the pain better and do regular exercises, even with pain, are the first line treatment. And for abdominal pain and this sort of pain, again, that needs to be clear what type of pain it is before I can give you kind of more detailed advice.
Fran: And the longer term benefits of physiotherapy, is that something where you would need us to attend on a sustained basis or is that something that an MSer could pick up?
Dr Bernhard Frank: I think currently I am in the luxury position to have actually physiotherapists working with me who are specialist pain physiotherapists and they normally would give you an assessment to work out what are the different pains you suffer from, and they will give you a kind of an exercise sheet, you know, which you need to do at home, because physio only works by doing that regularly so that you get the training effect and then I will follow you up a few times to see that you are doing the exercises properly. So I think it’s a mixture of having kind of a physiotherapist involved, but it relies quite a lot on MS patients to do the exercises on a regular basis at home and hopefully there are some relatives who can help them if it’s very difficult. But it’s important to just keep the body active and keep the muscle tone up, because if this deteriorates, the musculoskeletal pain will probably get much worse rather than better.
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