Initially strange and sometimes uncomfortable sensations of many kinds are typical effects of Multiple Sclerosis. A person can feel these symptoms but the doctor may to be able to find clear physical evidence of why particular symptoms are caused. They are related to damage to the nervous system. They may take various forms, and are frequently intermittent. Doctors often regard these symptoms as relatively benign because, although they may be irritating, they do not, on the whole, tend to result in major problems in daily functioning. Many people with MS get to know the situations in which these sensations occur and adjust their everyday lives as much as possible to avoid those situations. Some may be uncomfortable but can be tolerated. Others may be helped by remedies that you can use yourself. Yet others may require medical advice, support and treatment.
It is often felt by doctors that, although it is now recognized that pain is more frequent and often more severe than previously thought, it does not generally lead to decreased mobility, and is not associated with a poor prognosis. This may of fer some comfort to those who have pain from their MS.

‘Burning’

A burning pain can occur in your arms, legs and in other parts of your body. Medically, this is often called ‘dysaesthesia’ and results from abnormalities in the sensory pathways in the nervous system. After exercise, or at night, this burning pain may get worse. Unfortunately, ordinary pain medications do not usually have much effect on this kind of sensation. Antidepressant medications such as amitriptyline may be used for relief if it becomes too problematic, or other remedies, such as antiepileptic drugs (gabapentin and carbamazepine), may be used to try and alter conduction along the nerve fibres, which has produced the sensation.

‘Pins and needles’

MS af fects many nerve pathways in the CNS, and those related to sensations in the body are particularly prone to damage. Depending on where the damage occurs, you may feel all sorts of unusual sensations in those areas. The sensation of pins and needles commonly occurs with the interruption and resumption of nerve signals to particular areas of the body. Closely related sensations, such as tingling, may also appear occasionally, as signals to and from the af fected area vary. Some clinicians treat this symptom as relatively unimportant, albeit a disconcerting, symptom of MS, for it has generally a less direct effect on everyday activities than ‘motor (movement) symptoms’, and is associated with a slower course of MS. As with the burning sensation, there is no specific drug therapy for such symptoms although, if the symptoms are associated with pain, a tricyclic antidepressant or sometimes medications such as carbamazepine and valproic acid (usually given for antiepileptic purposes) can help.

Trembling

Most people have some kind of ‘tremor’ (or trembling), albeit slight, as there are several different types. Your limbs will normally be the parts affected, as the course of the disease progresses. The most common is what is known as action tremor, although it can be described as intention tremor, goal-directed tremor, or hyperkinetic tremor. This is caused by damage to the nerve pathways to the balance centre of the brain. The nearer your hand approaches an object when reaching for it, the more your hand trembles, so it then becomes difficult either to pick up or control something like a cup. Other kinds of tremor are much rarer.
As there are no specific drugs for the treatment of action tremor, doctors tend to try a range of dif ferent ones in the hope that one or other may prove of benefit, but it is difficult to avoid unwanted effects. Drugs known as beta-blockers, such as propranolol, might help. People often tend to develop ways of helping themselves. These include such things as:

• bracing an arm against a piece of furniture;
• making the arm immobile for a specific task;
• working out movements with a physiotherapist that are as smooth as possible;
• adding weights to an arm, using weighted utensils such as forks and spoons.

A far more drastic approach to reduce action tremor is through surgery, but currently this operation carries considerable risks of exacerbating other problems, and could make life worse, not better, for you. Various newer surgical procedures to control tremor are under development, including the implantation of electrodes, but many of these are still only experimental and, in any case, may only be useful for a small group of people with MS.

Numbness

Numbness is quite a common and upsetting symptom in MS, although it can be only temporary if you have a relapse. There may be other strange and sometimes unpleasant skin-based sensations. Usually the worst of these will ‘wear off ’ relatively quickly, although they may stay for days and sometimes longer. Because sensory nerves, in various parts of the CNS, link to all parts of your body, inflammation or damage to them can produce numbness almost anywhere, but particularly in your feet, hands, limbs or face. You may think the nerve damage has occurred where the numbness is; in fact the damage will be in the CNS, often well away from where the symptom appears. Numbness in the hands can cause difficulties for holding or picking things up, particularly those that are hot or sharp. Check carefully where and how you are walking, if the numbness affects your legs.
Even though depression may not be present, again tricyclic anti- depressants can help to reduce the feeling of persistent numbness, and intravenous steroids can be used when the numbness is, or appears to be, associated with a relapse.

Sensations and heat

The extent to which the symptoms of MS appear to change with temperature differences has been known for a long time. In fact, with what seems now to be extraordinary insensitivity, people with suspected MS used to undergo the ‘hot bath’ test, in which they were given a hot bath. If their symptoms became worse, this was thought to indicate that MS was indeed a possible diagnosis.
Heat, particularly enhanced body heat, changes the process of nerve conduction, and may result in the sensation of weak muscles and limbs. Heat can also exacerbate other symptoms, such as pain associated with inefficient nerve transmission. Conversely, when the core body tempera- ture is cooler, nerve conduction and muscle function appear to be better, particularly in MS. In general, therefore, people with MS are right to try and avoid situations where their core body temperature is raised.
Tests have been made on body cooling systems, which could be used to maintain a lower body temperature in hot conditions, or more generally to improve the performance of a person with MS in many dif ferent temperature ranges. Other approaches to the problem have been more limited and functional: the use of cold or frozen gel packs held in special vests, so that working or undertaking other activities in hot conditions does not raise your body temperature to any great degree.