Transcript Jennifer Finley, MD, FAAPMR, CIME

Jennifer Finley, MD, FAAPMR, CIME
Private Practice
Physical Medicine and Rehabilitation
Overland Park, KS
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The estimated pain prevalence in MS varies
between 30% and 90%
The frequency of reported pain in MS patients is
not higher than in the background population.
However, pain intensity, the need for analgesic
treatment, and the impact of pain on daily life is
higher in MS patients.
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A conscious experience
“The unpleasant awareness of a noxious stimulus
or bodily harm”
"an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage”
“Pain is whatever the experiencing person says it
is, existing whenever he says it does"
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Functional Pain or “Good” Pain
 There for a good reason
 Protective device
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Chronic Pain or “Bad” Pain
 Serves no real function
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Central
Spasticity
Musculoskeletal
 Mechanical
 Postural/Biomechanical
 Weakness or Relative
Weakness
 Pressure/Seating
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Medication Related
“The Usual Culprits”
It depends on where the pain is coming from!
What is causing your pain may be totally
different from what is causing very similar
pain in somebody else.
Beware of internet advice! Consider the source.
Tell your doctor what you’re doing that he/she
didn’t prescribe.
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Emotional Component
Stress Management
Relaxation Techniques
Biofeedback
Acupuncture
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Massage
Mediation/Focus
 Tai Chi
 Yoga
 Diaphragmatic
Breathing
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Neuropathic Pain Treatment
 Avoid painful stimuli and situations that provoke pain
 Medications:
 There are no FDA approved “on label” drugs
specifically for MS pain. All drug treatment is
“off label”
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Anticonvulsants:
 Gabapentin (Neurontin)
 Pregabalin (Lyrica)
 Carbamazepine
(Tegretol)
 Phenytoin (Dilantin)
 Lamotrigin (Lamictal)
 Zonisamide (Zonagran)
 Topiramate (Topamax)
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Antidepresants:
 Selective Serotonin and
Norepinephrine
Reuptake Inhibitors
(SSNRIs):
 Duloxetine (Cymbalta)
 Tricyclics:
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Amitriptyline (Elavil)
Imipramine (Tofranil)
Doxepin (Sinequan)
Protriptyline (Vivactil)
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Baclofen:
 Oral
 intrathecal (ITB)
Botulinum Toxin:
 Botox
Myobloc
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Anesthetics:
 Bupivacaine
(Marcaine)
 Lidocaine (Lidoderm)
 Mexiletine
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Miscellaneous:
 Dronabinol (Marinol)
 Amantadine (Symmetrel)
 Misoprostol (Cytotec)
 Steroids (prednisone, Medrol)Sandostatin)
 Acetazolamide (Diamox)
 Octreotide (Sandostatin)
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Physical Measures:
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Stretching
Positioning
Splinting
Ice
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Medications:
 Pills:
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Injectables:
 Baclofen (Lioresel)
 Botulinum toxins:
 Diazepam (Valium)
 Botox
 Myobloc
 Clonazepam
(Klonopin)
 Tizanidine (Zanaflex)
 Intrathecal Baclofen
 Dantrolene
(Dantrium)
Device Related
 Pressure on Nerves
 Overuse
 Immobility
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Stiff, Sore Joints
Pressure on Nerves
Skin Issues
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Weakness
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MS
Deconditioning
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Poor Posture
 Standing
 Sitting
 Wheelchair
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Correct as many
mechanical problems
as possible:
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Posture
Body Mechanics
Trigger Points
Weakness
Deconditioning
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Physical Therapy
Physical Activity
 Catch 22!
 Get Out of the Chair
 Get into a Chair/Scooter
Questions & Answers
Jennifer Finley, MD, FAAPMR, CIME
Board Certified Physical Medicine and
Rehabilitation
10770 El Monte, Suite 102
Overland Park, KS 66211
(913) 681-1620