Around 20 percent of people living with multiple sclerosis (MS) experience back pain. This can be a direct symptom of MS or caused by other health conditions and lifestyle factors. Because back pain has many potential causes, people with MS may experience a wide range of symptoms, including dull, aching muscles and “electric shock”-type nerve pain.

Meeting with your physician for a full evaluation is an important step in determining the root cause of your back pain. Once your doctor knows what’s causing it, they can help you find interventions that won’t interfere with your MS treatment. Managing back pain can greatly improve your mental health and quality of life.

What Does MS Back Pain Feel Like?

Many MyMSTeam members have shared their personal experiences with back pain caused by MS:

• “After walking a very short distance, the pain starts in my lower back and spreads all over my body. It’s so painful, I feel like I might crumble to the floor.”
• “The pain can be a dull, but awful, ache or a constant pain in my upper torso. The pain is worse between my shoulder blades but can roam around my back. Lying down is difficult, sitting is agony, but standing is tolerable.”
• “I started with neck pain, which then turned into severe tailbone pain that I still have. I can’t sit! I have to sit on my side, which is causing other issues. Now I’m struggling with upper and lower back pain.”
• “I have excruciating neuropathic pain in my right hip (buttock) that radiates down my leg, causing terrible pain in my calf and foot. My lower back is always in pain.”
• “I have a strong, intense sensation of pressure in my spinal cord up to the base of my skull. I’ve also experienced high impulse pain signals that zap various parts of my body. The zaps last about 10 seconds and then dissipate, only to return again in 10 minutes or several hours.”

Potential Causes of Back Pain

Back pain in people living with MS can stem from a variety of sources — some directly related to MS and others that can affect anyone. Understanding these possible causes can help you and your healthcare provider identify what’s behind your discomfort and choose treatments that work for you.

“I started with neck pain, which then turned into severe tailbone pain. Now I’m struggling with upper and lower back pain.”

— A MyMSTeam member

1. Musculoskeletal Pain

Weakened muscles and impaired coordination can lead to poor posture and an altered gait (walking pattern) in people with MS. These issues often cause chronic back or hip pain.

One MyMSTeam member shared how their back pain changes throughout the day, affecting their posture: “When I wake up, my leg muscles and body are stiff and achy. I walk bent over in the morning, but after a few hours, I walk better.”

Modifying your home, wearing specific types of shoes, and using assistive devices like a walker can help you avoid injury and stay independent. In addition, pain medication, exercises, and stretches may ease this type of pain. Your neurologist can refer you to a physical or occupational therapist to help with this.

2. Lhermitte’s Sign

People with MS may notice a sudden, electric shock-like sensation running down their spine, often triggered by bending their neck forward. This symptom, known as Lhermitte’s sign, can sometimes be one of the first signs of MS or an MS flare-up (also known as a relapse, which refers to periods of new or worsening symptoms).

Lhermitte’s sign is a type of nerve pain that often occurs when MS causes damage to the cervical spinal cord (the portion of the spinal cord that runs through the neck).

Several MyMSTeam members have shared what back pain due to Lhermitte’s sign feels like:

• “Lhermitte’s was one of my first MS symptoms — bending my neck would send a shock sensation from my spine to my toes. I still feel it now, without bending my neck, down my left thigh, right foot, and right wrist.”
• “It feels like I’m plugged into an electrical outlet. I can’t think of normal things, like the word ‘kitchen.’ Every time I move, I get this electric charge. I’m so exhausted.”

Notify your healthcare team right away if you experience Lhermitte’s sign, as in some cases, it might mean your MS is active. Getting a prompt diagnosis allows for quick intervention.

A few options that may reduce the feeling include:

• Applying pulsed electromagnetic field (PEMF) therapy (a noninvasive treatment that uses low-level electromagnetic waves)
• Using a neck brace to limit movements that trigger symptoms
• Practicing progressive muscle relaxation and gentle stretching with guidance from a physical therapist

3. Muscle Spasms

Muscle spasticity — which refers to muscle stiffness, tightness, or spasms — can be an MS relapse symptom. Along with the limbs and the torso, the back is a frequent site for these spasms. Sometimes, these involuntary muscle contractions can be painful and last for several minutes.

“Muscle spasms cause my legs, arms, and back muscles to be so sore, it feels like I worked out hard!”

— A MyMSTeam member

Many members of MyMSTeam have shared how spasms impact their daily lives. One member shared, “I have severe spasms at work, and a co-worker has had to catch me to keep me from falling. I also have them at the grocery store, and it’s so frustrating. I get them during church, and they’re so bad, the nurses and ushers come over to help me (mainly so I don’t collapse).”

“Muscle spasms cause my legs, arms, and back muscles to be so sore, it feels like I worked out hard!” another member shared.

If your back pain is related to muscle spasms, your neurologist may refer you to a physical or occupational therapist for treatment. Other options may include:

• Botulinum toxin type A (Botox) injections to help relax overactive muscles
• Oral or injectable muscle relaxants to reduce spasm frequency and severity
• In severe cases, a baclofen pump, a surgically implanted device that delivers a continuous dose of the muscle relaxant baclofen directly into the fluid around your spinal cord

4. Degenerative Disk Disease

Degenerative disk disease — a condition that affects the spinal disks and the joints between the bones of the spine — is common and can occur alongside MS.

Several MyMSTeam members have described how back pain from degenerative disk disease feels and how it changed over time:

• “I have always had upper and mid-back pain, neck pain, and lots of problems with spasticity, pain, and cramping, mostly in my legs and back. Then, I suddenly developed severe, unrelenting low back pain that shot through my hips and down my legs. I found out that I also have degenerative disk disease.”
• “An MRI showed a slipped disk in my lower back. My doctor thought my MS was getting worse, but it was just a slipped disk.”

Doctors often recommend starting treatment with over-the-counter pain relievers and anti-inflammatory medications. Depending on the severity of symptoms, other treatments may include:

• Prescription muscle relaxants to ease associated muscle spasms
• Short-term use of prescription opioids for severe pain, when other medications are not enough
• Epidural steroid injections to reduce inflammation and pain around the affected nerves
• Surgery for cases involving significant nerve compression or structural instability in the spine

Some people also find relief through physical therapy, gentle yoga, and complementary approaches such as acupuncture.

Always discuss new or alternative therapies with your healthcare provider to ensure they are safe for you.

5. Osteoporosis

Osteoporosis is a condition that makes bones less dense, weaker, and more likely to break. Doctors may recommend bone density testing — such as a dual-energy X-ray absorptiometry (DEXA) scan — for people living with MS, especially if other risk factors are present.

Other factors that can also contribute to weakened bones include:

• Long-term inflammation
• Low vitamin D levels
• Reduced mobility due to MS
• Certain medications used to manage MS symptoms or relapses

In addition, some people are more likely to develop osteoporosis because of genetics or nutrition and exercise patterns during childhood and adolescence.

One MyMSTeam member shared how it can be difficult to pinpoint the cause of their back pain: “I have osteoporosis and MS. I also have osteoarthritis in my spine. Sometimes it’s hard to tell what’s causing my pains! Some days the pain is less, but I always have some degree of pain.”

A balanced diet with enough vitamin D and calcium — sometimes with the help of supplements — can help maintain bone strength. Talk with your healthcare provider before starting any supplements, as they can help you determine the right type and dose and check for interactions with your medications. A registered dietitian can also help you create an eating plan that supports bone health and fits your lifestyle.

Medications available for treating osteoporosis include:

• Bisphosphonates, often the first-line option for slowing bone loss
• Denosumab, a biologic medication sometimes preferred for people with kidney problems

Your healthcare provider can help determine the safest and most effective treatment plan for your needs.

“I also have ankylosing spondylitis and osteoarthritis. My pain and stiffness are worse during the night and early morning.”

— A MyMSTeam member

6. Other Possible Causes

There are many other common causes of back pain that can affect both people with MS and those without. These include:

• Ankylosing spondylitis or other types of spinal arthritis
• Endometriosis
• Fibromyalgia
• Infections such as osteomyelitis or discitis
• Kidney stones or kidney infections
• Myofascial pain (chronic pain affecting the connective tissue that covers muscles)
• Obesity
• Pregnancy
• Scoliosis (curvature of the spine)
• Spinal stenosis (narrowing of the spinal canal)
• Sprains, strains, or other injuries
• Tumors (growths, both cancerous and noncancerous)

One MyMSTeam member shared, “I also have ankylosing spondylitis and osteoarthritis. My pain and stiffness are worse during the night and early morning.”

Talk With Your Doctor About Back Pain

Because people with MS may experience pain differently, it’s important to describe your symptoms to your healthcare provider in detail — including where you feel pain, what it feels like, and when it occurs. Keeping a brief pain diary can help you track patterns and share them at your next appointment. Clear communication with your healthcare provider can help identify the underlying cause and guide effective treatment.

Find Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

What treatment options and interventions have you tried for back pain? Do you think your chronic pain is caused by MS alone? Are other health conditions contributing to your back pain? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.