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Nerve Pain and Muscle Cramps

  I would appreciate any suggestions for relieving nerve pain and muscle cramps associated with MS.  I gave Amytriptiline a try at 10mg, then 20, then 30mg at night.  Even at 10mg, I was tired and sluggish in the morning.  By 30mg it was worse and still no real change in the nerve pain.  The muscle cramps started about two weeks ago, with cramps in the calves at night.  Then it progressed to stomach muscle cramps, cramps in the back of my thighs, hands and feet, and not just at night.  The nerve pain comes and goes, mostly in my hands, arms and feet.  What options are available and is there anything that won't reduce me to a walking slug?  Also are there any non medication things that I can be doing that will help?  Several people have also mentioned magnisium.  Would that be beneficial, and if so, how much?  Thanks.  Oh, I also have autoimmune hepatitis, so I do have to be careful about drugs that would be especially harmful to my liver, or not work well with immuran.  Thanks.  Dianne

Dear Dianne:
Neuralgic pains and muscle cramps and spasticity are common in MS.
Nerve pain or neuralgic pain of the burning or dysesthetic kind is commonly treated with tricyclic agents such as amytriptiline or nortryptiline (which is less sedating). Lancinating or shooting neuralgic pains are commonly treated with anticonvulsant-like medications such as carbamazepine or gabapentin. Either set of drugs may have some effect in either type of pain, and the use of combinations is not infrequent.
These drugs, however, are less effective in the treatment of muscle cramps ("charlie-horse" type). In contrast quinine and some other drugs with effects on sodium channels are effective here. Also, spasticity can cause significant discomfort in MS, and this is treated with yet other agents, such as baclofen and tizanidine.
Your neurologist would be able to figure out the major factors playing a role in your case, and should be able to figure out the best tolerated combination of medications to relieve your pain.

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