If you experience shoulder pain with multiple sclerosis (MS), it’s important to talk to your MS specialist about this symptom. Shoulder discomfort with MS may be chronic (long-lasting) or acute (short-term). It may be associated with nerve damage or muscle or joint pain. The doctor who treats your MS is the best person to help you identify the causes of shoulder pain and find effective ways to manage this symptom.

According to one study of 115 people with MS, pain in the shoulders and upper back are common symptoms. (The researchers also noted women were more likely to report pain in these areas.) Each person experiences pain differently, including those diagnosed with MS. For some, shoulder pain may feel sharp and sudden, while others may feel a dull, steady ache that lasts through the day.

Shoulder pain can affect your day-to-day activities and quality of life. Here, we explore how shoulder pain can affect those who are newly diagnosed with MS and those who have had the condition for a while. Learn what others with MS say about shoulder pain, and learn more about pain management options that could help.

Different types of pain can occur as symptoms of MS. No two people feel pain quite the same way, and shoulder pain is no exception. One MyMSTeam member reported feeling “tuckered out” due to MS spasms in their shoulders and shoulder blades. Other team members have described having lots of neck and shoulder pain. One even likened their pain to that of a dislocated shoulder. Another member said the pain was in both of their shoulders and paired with arm spasms. That member posted about “bad nights” with little to no sleep and being tired in the days that followed. In some people, pain extends to the collarbone, neck, and jaw.

Just like there are countless ways those with MS may experience pain, there are many different treatment options to manage and minimize shoulder pain specifically.

Remember that even if your pain may be similar to someone else’s, their pain management methods are not guaranteed to work for you. Ask your doctor for different pain management options to see which ones serve you best. And, before you try any new pain-management technique or treatment, first consult your neurologist or other health care provider. Discussing any new or worsening symptoms with your doctor is the best first step to determine the cause and best treatment options.

Over-the-counter pain relievers, such as ibuprofen (a nonsteroidal anti-inflammatory drug, or NSAID) and acetaminophen (a pain reliever) can often manage the musculoskeletal pain commonly associated with MS. However, the severity and frequency of your shoulder pain may determine whether your doctor prescribes stronger medications. This point emphasizes the importance of discussing your treatment options with your doctor long before the pain hits.

One MyMSTeam member posted that they knocked out their pain with two acetaminophen (Tylenol) pills. “My shoulders have really been bothering me,” they wrote. “And it’s been hard to sleep because I am a side sleeper.” Doing physical therapy and applying a menthol-based cooling gel (Biofreeze) made little difference, they continued. But, they shared, the simple over-the-counter drug acetaminophen eased their discomfort.

Another popular pain-relief option includes topicals: pain creams, ointments, gels, and patches. However, members have reported varying levels of success with these products. Some have found the treatments temporarily ease their pain, while others report no relief. Some members had allergic reactions after applying certain products, like those with corticosteroids (steroids).

Common nonsteroidal, over-the-counter topical pain relief options include those with active ingredients such as:

• Capsaicin (Therapatch Warm, Zostrix)
• Lidocaine (Solarcaine Cool Aloe, Topicaine)
• Menthol (Icy Hot, Biofreeze)

Steroid medications are another treatment choice for MS pain. Doctors tend to prefer steroid injections to surgery in certain situations, especially for people with MS. Injected steroids are less invasive than surgery and offer shorter recovery periods than surgical procedures.

Many MyMSTeam members have weighed in on their experiences with steroid medications. One member shared that steroids are a common treatment among people with MS — especially for those experiencing a flare that causes very intense shoulder pain.

“In my first 20-plus years with MS, I was prescribed an oral steroid two or three times a year due to an MS relapse,” posted one MyMSTeam member. “I then went into remission and have not required steroids since. Steroids can be considered a ‘miracle’ medication. However, they can also present difficult side effects.”

The member continued, “After a few days on them, you are feeling OK. Then you go through a period when you say, ‘Get me off of these steroids.’ I continue to be mobile today because my neurologist’s treatment for me included steroids.”

That member is correct: You may experience the side effects associated with steroid medications. Some MyMSTeam members have reported experiencing sleeping problems while on steroids. However, these side effects are more likely if you take oral steroids. Steroids given as an injection into a sore joint are more likely to be limited to temporary side effects right around the injection site.

If you experience mild discomfort or stiffness in your shoulder muscles or joints, your doctor may recommend muscle relaxants. These can treat both muscle spasms and tightness. One MyMSTeam member said over-the-counter muscle relaxants loosened their stiff shoulder. Muscle relaxants can be a convenient fit for those experiencing pain that they consider to be less severe. At that pain level, steroid injections and surgery might be overkill.

Some people find that using an ice pack or a warm compress eases their MS-related shoulder pain. Although these do not treat the underlying problem that causes the pain, they can soothe. Applying hot or cold packs can ease discomfort and relax numb, aching, or cramped muscles. A hot bath can be helpful, too, but don’t overdo it — heat can cause symptoms to worsen in many people with MS. Others may have sensitivity to cold.

Chronic pain and other MS symptoms can make lying or sitting down for long periods preferable — if not necessary. However, it is beneficial to move around as regularly as you can. If you experience difficulty when you move, ask your neurology provider for a referral to a physical therapist for help with gentle stretches and/or regular exercises. Try a moderate approach, though, as too intense and too much exercise can make your MS symptoms worse.

Adjusting your posture can have a big impact on shoulder pain and back pain. When sitting, place a small cushion or a rolled-up towel at your lower back to align your spine and shoulders and to maintain that proper position. When upright, you might use a device called a standing frame. Standing frames support you when you stand. Use them correctly to improve your posture and reduce strain on your muscles and ligaments.

On MyMSTeam, the social network for people with multiple sclerosis and their caregivers, more than 217,000 members come together to ask questions, give advice, and share their experiences with others who understand life with MS.

How does MS pain impact your daily life and mental health? Do you use relaxation techniques or any complementary therapies (such as acupuncture) as part of your treatment plan? Share your experience and tips in the comments below or by posting on MyMSTeam.