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. Since there are many potential causes of back pain, people with MS may experience a wide range of symptoms, including dull, aching muscles and “electric shock” type nerve pain.

There are many reasons why people with MS might experience back pain. Meeting with your physician for a full evaluation is the only way to determine the root cause. Once your doctor knows what’s causing your back pain, they can help you find interventions that won’t interfere with your MS treatment.

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.”
• “A morning of pain feels like electric pulses running through my body.”
• “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 thoracic spine 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.”

Managing back pain can greatly improve your mental health and quality of life. Here are some potential causes of back pain for people with MS.

Potential Causes of Back Pain

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 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, often triggered by bending their neck forward. This symptom, known as Lhermitte’s sign, is often the first sign of MS or an MS relapse. Lhermitte’s sign is a type of nerve pain that often occurs when MS causes damage to the upper part of the spine (cervical spine).

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 fields (EMFs), using a neck brace to limit neck movements, and practicing progressive relaxation and stretching with the guidance of a physical therapist.

3. Muscle Spasms

Muscle spasticity — which refers to muscle stiffness, tightness, or spasms — is common for people with MS. 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.

Many members of MyMSTeam have shared how spasms impact their daily lives. One member shared, “I have severe spasms at work, and a coworker 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).”

The pain left over from muscle spasms can also affect quality of life. As another MyMSTeam member stated, “Muscle spasms cause my legs, arms, and back muscles to be so sore, it feels like I worked out hard!”

If your back pain is related to muscle spasms, your neurologist may refer you to a physical or occupational therapist for treatment. Other management options may include botulinum toxin (Botox), muscle relaxants, or, in severe cases, a baclofen pump.

4. Degenerative Disc Disease

Degenerative disc disease — a condition that affects the bones and joints of the spine — is common and can coexist with MS.

Several members of MyMSTeam have also been diagnosed with degenerative disc disease and have described how their back pain symptoms 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 disc disease.”
• “An MRI showed a slipped disc in my lower back. My doctor thought my MS was getting worse, but it was just a slipped disc.”

Doctors usually recommend starting treatment with over-the-counter pain relievers and anti-inflammatory medications. Other management options may include prescription opioids, muscle relaxants, epidural injections, or surgery. Many people also find relief through physical therapy, yoga, and alternative treatments like acupuncture.

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. Other factors that can also contribute to weakened bones include inflammation, low vitamin D, MS-related immobility, and medications commonly used to manage MS pain. Additionally, some people have a higher chance of developing osteoporosis because of their genetics or their eating and exercise habits 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.”

Eating a balanced diet with enough vitamin D and calcium (usually with the help of supplements) can help keep bones strong. Several medications are available for treating osteoporosis, with bisphosphonates being a common first choice. Denosumab (sold as Prolia and Xgeva and also available as a biosimilar) is another option, sometimes preferred for people with kidney problems. Your healthcare provider will evaluate your situation to find the best treatment option for you.

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
• Infection (osteomyelitis or discitis)
• Kidney stones or infections
• Myofascial pain
• Obesity
• Pregnancy
• Scoliosis
• Spinal stenosis
• Sprain, strain, or another type of injury
• Tumors

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

People with MS may experience pain differently, so it’s important to tell your doctor what your symptoms feel like, including where and when you feel them. When you experience back pain, consider writing down your symptoms so you can communicate them more effectively at your next appointment. Communicating clearly with your healthcare provider can help ensure the underlying cause of your back pain is managed effectively.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 218,000 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? 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.