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The MS hug is a painful symptom of multiple sclerosis (MS) that feels like a tight band squeezing the chest or ribs. Involuntary spasms in the small, intercostal muscles between the ribs cause pain that feels like a “girdle” around the torso.
The MS hug is one of the many pain symptoms affecting more than 55 percent of people with MS, according to the National Multiple Sclerosis Society (NMSS). Between 15 and 25 percent of those with MS report experiencing this odd - and sometimes frightening – type of nerve pain, medically known as dysesthesia.
Because chest pressure and pain from an MS hug can arise suddenly, it can be mistaken for other conditions such as gallbladder problems, heart or lung disease, or inflammation of the cartilage between the ribs (costochondritis). “I thought I was having a heart attack,” said one MyMSTeam member. Another member discovered after a year of hospital visits that she had a gallbladder problem. “It was the same type of pain, so it was tricky.”
Chest or abdominal pain can be a sign of a serious condition. It’s important to share the symptoms you’re experiencing with your doctor, so they can rule out other medical issues.
Each person experiences the MS hug differently. The symptom can cause tightness anywhere between the neck and waist, may be felt on one or both sides of the body, and can range from an annoying tickle to a vise-like grip that makes it difficult to breathe.
Here’s how MyMSTeam members describe the MS hug:
In multiple sclerosis, the body’s immune system attacks the central nervous system (CNS), which consists of the brain and spinal cord. MS symptoms are caused by damage to the myelin, a substance that protects nerves. When myelin is destroyed, it interferes with messages sent from nerves to the brain and body, causing a wide range of symptoms.
With MS hug, pain symptoms are related to nerves (neuropathic), muscles (non-neuropathic), or both. Nerve damage produces the abnormal sensations of the MS hug and muscle spasms create the pressure, tightness, and aching.
Heat, stress, and exertion are common triggers of multiple sclerosis symptoms - and the MS hug. The hug can also be triggered by a flare or relapse. As with many MS pain symptoms, neurologists recommend rest, cooling down, and reducing stress. Members of MyMSTeam report that stress brings on their MS hugs - or makes them worse. “As soon as I get stressed, (the hug) symptoms get worse,” explained one member.
Speak with your doctor about anything you think may be triggering your MS hug symptoms.
Although the MS hug is not life threatening and generally passes with time, the spasms may be uncomfortable and interfere with your daily life. Because the hug is different for everyone, treatment will vary. Your neurologist may recommend one or a combination of medications to treat MS hug.
Neurontin (Gabapentin) is one of the first medications neurologists prescribe off-label to treat MS neuropathic pain. Lyrica (Pregabalin), an anticonvulsant and analgesic, is approved and prescribed for neuropathic pain. The drugs are believed to work by reducing pain signals sent by damaged nerves. “Taking Gabapentin twice a day calms down my nerve and spasming pain,” said a MyMSTeam member. “Lyrica helped relieve the tingling sensations,” said another member.
Elavil (Amitriptyline) is a tricyclic antidepressant that is sometimes prescribed to treat neuropathic pain and depression associated with MS. It’s believed to help by changing the balance of neurotransmitters in the brain. Many MyMSTeam members have been prescribed Elavil for pain and muscle spasms with mixed results. “Elavil helps the pain, but I feel drunk afterwards,” said one member.
Lioresal (Baclofen) is a muscle relaxant and the preferred drug for treating spasticity in MS. It may relieve cramping, muscle tightness, and spasms. “I've taken Baclofen for years. It works about 50 percent of the time,” said one member of MyMSTeam. Another added, “I've been on it for years and went from multiple daily spasms to just a few a month.”
Common painkillers are a first-line treatment for spasticity. Some members of MyMSTeam have found temporary muscular relief with aspirin, Advil or Motrin (Ibuprofen), or Tylenol (Acetaminophen). Members also use topical pain-relief creams or ointments to loosen tight muscles.
Botox injections have typically been used in MS to treat bladder dysfunction. But some neurologists are using it as a muscle relaxant for the spasticity that occurs with an MS hug. “Today I really noticed the tension releasing; ‘frozen solid’ muscles beginning to ‘thaw,’” said one member who receives Botox.
Several studies have shown evidence of cannabinoids’ potential in treating MS spasticity, as summarized in a 2018 systematic review. Sativex (Nabiximol), a cannabis-based mouth spray found to help muscle spasms, is approved for use in the UK.
Because the MS hug may last for a few seconds or hours, many members of MyMSTeam often do nothing and wait for symptoms to pass. When MS hug pain or discomfort becomes unbearable, members report some success with many of the same remedies and complementary and alternative medicine (CAM) therapies that help with general MS pain. They include:
Some MyMSTeam members have found that ice or heat applied to the affected area can help relieve symptoms. One member places a towel-wrapped ice pack on his ribs. “It feels really good and helps tremendously,” shared the member.
Applying pressure to pain with the palm of your hand - or wrapping your body with an elastic bandage - may help relieve tension that worsens the MS hug. Some people find that loose, lightweight clothing works best when the skin feels tingly or prickly.
Older studies suggest that magnesium, along with calcium and vitamin D, can reduce spasticity in MS. “The best relief I get is from magnesium. About 99 percent of the time it really works,” shared one member.
A 2014 literature review found that acupuncture may have potential to relieve MS pain and discomfort, but more research is needed. Anecdotally, some members of MyMSTeam have had good results with the therapy. “I’m in my fifth month using Chinese medicine for MS and have more or less stopped all other meds. Feeling OK, and a lot less MS hug,” shared one member.
Techniques such as deep breathing and meditation have been found to ease MS pain. A 2011 study reported that participants in a meditation program showed significant overall improvement in lowering pain levels.
“I find that breathing techniques, rest and some yoga poses actually help,” said one member. “I just try to relax even when it's hard to breathe. The hug pain eventually lets go,” said another.
Yoga, stretching, and other light exercise has shown to be beneficial in helping reduce MS pain and stress. Yoga postures can be adapted to any ability or be performed while seated. “Yoga and stretching have been very helpful in keeping me mobile,” said one member who struggles with muscle spasms and tension.
Keeping a diary of pain symptoms can help your doctor better manage and treat triggers and severity.
Always consult with your neurologist or primary care physician before making any changes to your prescribed MS health care regimen.
By joining MyMSTeam, members gain a community of more than 140,000 people living with MS who understand their challenges, including the MS hug. Members support each other and share ways they have found to manage MS symptoms.
Here are some conversations about the MS hug:
Here are a couple of question-and-answer threads about the MS hug:
Have you experienced the MS hug? How do you manage the discomfort? Share your experiences in the comments below or on MyMSTeam.
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