There are many reasons why people with multiple sclerosis (MS) might experience back pain. Back pain may be a direct symptom of MS, or it could be caused by other health conditions and lifestyle factors. A review of past research found around 20 percent of people living with MS experience back pain. On MyMSTeam, more than 6,600 members living with MS report back pain.

Meeting with your physician for a full evaluation is the only way to determine what’s causing your back pain. Once you get to the root of the problem, you can find interventions that don’t interfere with other ways of treating MS.

Getting a handle on back pain can significantly improve your mental health and quality of life. Here are some potential causes of back pain and treatment options to consider.

1. Musculoskeletal Pain

When walking with MS, weakened muscles and impaired coordination can lead to poor posture and an altered gait (the way you walk). These issues can cause chronic (ongoing) back or hip pain.

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 your symptoms. 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 after bending their neck forward. This symptom, known as Lhermitte’s sign, is often the first sign of MS or an MS relapse.

Notify your health care team right away if you experience Lhermitte’s sign, as it might mean your MS treatment plan is falling behind. Getting a prompt diagnosis lets you intervene quickly.

Treatment options may include the application of pulsed electromagnetic fields (EMFs), a neck brace to limit neck movements that could make the problem worse, and progressive relaxation and stretching under the supervision of a physical therapist.

3. Muscle Spasms

Muscle spasticity — muscle stiffness, tightness, or spasms — is not unusual for people with MS. Along with the limbs and the torso, the back is a common site of spasms. Sometimes, these uncontrolled contractions can be painful and last for several minutes.

Members of MyMSTeam have described the profound impact of spasms on their daily lives. One member shared, “I have severe spasms at work, and a coworker has had to catch me to keep me from hitting the floor. 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).”

Your neurologist can refer you to a physical therapist or occupational therapist for treatment. Botulinum toxin (Botox) or muscle relaxants may also help. In severe cases, a baclofen pump might be the best treatment.

In addition, several MyMSTeam members have found CBD oil helpful for muscle spasms. Others noted that it took time for their health care team to find the right dosage of medications, but once they did, they noticed improvements.

4. Degenerative Disk Disease

Degenerative disk disease — a condition that affects the bones and joints of the spine — is often confused with MS because the symptoms and age of onset are similar. However, it’s also possible to have both conditions at the same time.

Doctors usually recommend starting treatment with over-the-counter pain relievers and anti-inflammatory medications. If that doesn’t work, they may suggest prescription opioids, muscle relaxants, epidural injections, or surgery. Many people also try physical therapy, yoga, and alternative treatments (like acupuncture) to reduce pain. Wearing a back brace and using heat or ice packs may also help.

Some people with MS take supplements to help with pain. “I use a curcumin supplement daily, and the inflammatory pain in my neck from degenerative joint disease is greatly reduced! I am banned from nonsteroidal anti-inflammatories (NSAIDs) due to GI problems. Look for a supplement that is well-researched and independently tested for potency and purity. The curcumin hasn’t bothered my stomach at all!” shared one MyMSTeam member.

Talk to your health care provider before starting a supplement, especially if you take multiple medications for MS or other health conditions. Some supplements can interfere with prescription medication.

5. Osteoporosis

Osteoporosis is a condition that makes your bones weak and brittle. Doctors often recommend bone density tests, such as a dual-energy X-ray absorptiometry (DEXA) scan, for people with MS. High inflammation levels, low vitamin D, and MS-related immobility that make regular exercise difficult may contribute to weakened bones. Steroids and other medications commonly prescribed for MS pain can also affect your bones. Additionally, some people have a higher chance of osteoporosis because of their genetics or their eating and exercise habits during childhood and adolescence.

Eating healthy foods and getting sufficient vitamin D and calcium (usually with the help of supplements) can help keep bones strong. Depending on your risk of injury and the severity of osteoporosis, your health care team can recommend the appropriate type and level of physical activity for you.

Several medications are available for osteoporosis treatment. Bisphosphonates are a popular first choice and include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast). Some bisphosphonates are taken as a weekly or monthly pill, while others are given as a quarterly or yearly infusion.

Denosumab (sold as Prolia and Xgeva) is another option, sometimes preferred for people with kidney problems. Your health care provider will evaluate your situation to find the best treatment option for you.

6. Other Possible Causes

Many other common causes of back pain affect people with MS and those without. These may include:

• Ankylosing spondylitis (a type of spinal arthritis)
• Endometriosis
• Fibromyalgia
• Herniated disk
• Infection (osteomyelitis or discitis)
• Kidney stones or infections
• Obesity
• Pregnancy
• Scoliosis
• Spinal stenosis
• Sprain, strain, or another type of injury
• Tumors

Muscle stiffness, joint pain, and nerve pain are common symptoms of MS and other progressive inflammatory conditions. Receiving treatment for the underlying cause of chronic pain is crucial in an MS treatment plan. Additionally, mindfulness-based pain management strategies and taking care of mental health side effects are also essential.

People with MS experience pain differently, it’s important to tell your doctor what your symptoms feel like and where and when you feel them. You may want to make some notes when you feel back pain, so you can refer to them at your next appointment. Communicate clearly with your doctor to receive the best care.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 197,000 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, or are other health conditions contributing to the problem? Share your thoughts in the comments below, or start a conversation by posting on MyMSTeam.