What are the most effective treatments for multiple sclerosis (MS) pain in patients with co-existing cancer requiring chemotherapy treatment? —Name withheld on request
Pain can be a frequent symptom of MS, occurring in approximately half of patients with the disease.1 Patients may experience acute or chronic pain described as burning, stabbing, pins-and-needles, or other symptoms.
Pain may be neuropathic in nature, or nonneuropathic and secondary to other MS complications such as spasticity.
Medications to treat MS pain include those used for other forms of neuropathy, such as tricyclic antidepressants (TCAs), other antidepressants such as the serotonin and norepinephrine reuptake inhibitors, antiepileptic drugs, opioids, antispasmodic agents, and topical agents.1 Patients with MS pain may also require additional medications to modify their disease course and manage other MS symptoms. These disease-modifying medications, and other agents used to treat MS symptoms, should be managed by providers with experience treating MS. Selection of an appropriate agent to treat pain caused by MS should be done with consideration of the symptom severity and their overall MS disease course.
As with other medications, agents used to control MS symptoms and modify the course of the disease can have a variety of interactions with cancer treatment. These interactions may increase drug toxicity, reduce efficacy of MS or cancer therapy, or cause adverse effects that overlap with the symptoms of MS (eg, taxanes may exacerbate symptoms of neuropathy). Management of these interactions and other issues involved in the care of these patients depends on many patient specific factors such as treatment modalities being utilized, goals of cancer therapy, symptom etiology and severity, and the clinical significance of the interaction. Therefore, management should be done with consideration of these and other needs and should include input from Oncology, Neurology, and other appropriate health care teams.
Managing the needs of patients with multiple medical conditions can truly be a balancing act. When a patient’s medical conditions are this significant, clear and timely communication between the patient’s care teams is critical to ensure coordination of care and promote the best outcomes for the patient. Nurses play a pivotal role in relaying patients symptoms and concerns, and can promote effective communication with patients and other health care providers.
1. Maloni H. Pain. National Multiple Sclerosis Society Web site. http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain. Accessed October 5, 2015.