This Is MS Multiple Sclerosis Community: Knowledge & Support

MS HUG INFORMATION: In honor of our TiMS' friend, George, may he rest in peace.

In simple terms, the MS Hug is a tight, often painful banding around, or partly around, the trunk which includes the muscles of the chest wall, ribcage (intercostal), and abdomen. The tightness and pain are caused by lesions in the spinal cord. Other muscle groups that can be similarly affected are the scalp, neck, shoulders, arms, hips, and legs.

The MS Hug, with a constellation of neurological symptoms, is not well described in the medical literature nor well known in the medical world, and to my knowledge, this post is the first effort to gather this much comprehensive information about the MS Hug. Many sources were used, including Internet MS message boards, national MS patient-advocacy organizations, medical textbooks, various dictionaries, and clinical studies and review articles, among other sources.

Intercostal Neuralgia - Pain and spasms of intercostal muscles located between the ribs.
Truncal Dystonia - Sustained "directional" contractions of trunk muscles bending, stretching, twisting, and holding abnormal postures/positions.
Abdominal Wall Dystonia - Sustained "directional" contractions of abdomenal muscles bending, stretching, twisting, and holding abnormal postures/positions.

MS Hug Symptoms - Motor and Sensory:
Itching - Usually on back. Lyrica and neurontin may help. Can be early symptom of MS Hug.
Hiccups - Involve the diaphragm and intercostal muscles.
Paralysis - Diaphragm (C3-C5), intercostal rib and abdominal wall muscles. Loss of trunk control (inability to hold oneself in sitting position), severe breathing problems. Be sure to tell surgeons and anesthesiologists about impaired breathing.
Dystonia - Caused by lesions in basal ganglia (deep in brain). Classifications are focal and secondary (to MS).
Tightness - Spasms or sustained contraction of chest wall, intercostal, and/or abdominal muscles.
Cramping - Abdominal cramps, can be severe.
Numbness - Usually on back, patchy. Can be early symptom of MS Hug. Lyrica and neurontin may help. More info here.
Pnuemonia - Caused by aspiration or when coughing up secretions becomes difficult leading to bacterial or viral pneumonia.
Constipation - Upper portion of gastrointestinal tract may be involved and gastroparesis may occur.
Pins and Needles - Usually on back. Lyrica and neurontin may help. More info here.
Connective Tissue - Small tears within thoracic cavity, painful.
Shallow Breathing - Caused by tight and/or painful rib muscles and/or weak or paralyzed diaphragm; possible low oxygen levels. Be sure to tell surgeons and anesthesiologists about impaired breathing.
Pain and Spasticity - Usually left-sided. Can be focal, diffuse, steady, intermittent, acute, chronic, wave-like, and/or band-like. Quality of pain can feel electrical, deep, sharp, and/or dull. Intensity of pain can range from mild to suicidal. Hyperalgesia is amplified pain.

Types of Pain and Spasticity:
Musculoskeletal - tightness, tenderness, soreness, achiness, pressure; burning, squeezing, slicing, crushing, strangling (of low neck), stabbing, tearing, throbbing, gnawing, pulling, gouging, and lancinating (cutting). "Doctor, there's a boa constrictor squeezing me to death, an elephant crushing me to death, a knife stabbing me to death, and a shark gnawing me to death!"
Osseous (bone) - Ribs feel bruised, fractured. Deep, aching pain. "Doctor, I woke up with broken ribs poking through my breast!"
Cutaneous (skin) - Dysesthesias include prickling, itching, stinging, pins and needles, numbness, burning, freezing, and allodynia (light touch pain). "Doctor, I get random itches and numb spots on my back!"
Visceral (organs) - Liver, gallbladder, stomach, intestinal, esophogeal, and kidney pain. Can be due to abdominal wall muscle and organ spasticity and should be considered for pwMS before exploratory abdominal surgery is performed. Stomach spasms can prevent food from entering stomach, cause vomiting of contents from stomach, and be extremely painful. Right-sided, low ribcage pain from "floating" 12th rib can be mistaken for gallbladder attack. "Doctor, I feel like I'm having a gallbladder attack!"



Treatments for Pain and Spasticity - In order of invasiveness, imo. NMSS Clinical Bulletin
Heat & ice packs
Stretching muscles - Yoga, Pilates, P.T.
Lidoderm 5% script - Lidocaine patches.
Acupuncture & TCM - Eastern vs Western.
Trigger pt. injections - for back of ribcage.
Intercostal nerve block - for front of ribcage. More info and diagram here
Medicinal marijuana - for muscle spasms.
Big-pharma medications - for pain and spasms.
Radiofrequency ablations - for pain and spasms.
Epidural steroid injections - I will not recommend. See article here.
Neurolysis AKA Rhizotomy - sensory nerves killed.
Spinal Cord Stimulator (SCS) - very invasive surgery.
Baclofen/pain Pump - Biogen - very invasive surgery.

Treatments for Breathing:
Nebulizer - to treat bacterial and viral pneumonia.
Cough Medicine - to treat dry (suppressant) or productive (expectorant) coughs.
Antibiotics/antivirals - to treat bacterial and viral pneumonia.
Incentive spirometer - to help improve lung function.
Cough assist machine - to help bring up secretions and phlegm.

Differential Diagnosis - Partial listing:
Fractured rib(s), heart attack, gallbladder attack, pulmonary pathology (e.g., pleurisy), renal pathology, biliary tract pathology, duodenal and gastric ulceration, costochondritis, spinal problems, and nerve entrapment.

FINAL EDIT -
Thank you, George, for having shared time and tears with me.

timeless tears
like drops of rain
until the day
came higher April rays
and dried our tears
away.

~~~~~~~~~~~~~~~~~

Post Script: Invasive Treatments and Opiod Medication

when i first had ms i told my neurologist i had a tight feeling around my chest and he said he never heard of it . wtf!

erinc, neurologists who don't know about the MS Hug have no business seeing MS patients. I've also heard of neuros who don't think MS causes pain! Idiots. I sure hope the tight feeling around your chest doesn't become painful and debilitating--wishing you the best of luck.

erinc quote: when i first had ms i told my neurologist i had a tight feeling around my chest and he said he never heard of it . wtf!


this shows how much the majority if not all of them listen to much of what the patient has to say or ask.

wonder how some of them would feel if they had a python snake wrapped around their chest squeezing them to death and they were trying to get someone to listen and help and everyone passing him by said-i don't see no snake! whats you talkin bout!

I also why my feet were always red and freezing cold and he said because I wasn't walking . I knew that wasn't it because it wasn't like that before ms. now i'm a believer that they want to keep ms for themselves .

Shameful that so many neurologists and MS specialists are DMD drug pushers and don't have a basic understanding of the human nervous system.

I totally agree !

Has anybody here ever tried a block injection (Intercostal Nerve Block) for the MS Hug (Intercostal Neuralgia) or Lidocaine I.V. ? I have had the MS Hug for about 4 years now and no drugs are helping with the pain. I am desperate for some type of pain relief so I have been researching the nerve block and lidocaine I.V. idea. They were suggested to me by a Anaesthiologist at a Pain Clinic.

It should be a medical board requirement that MS docs walk a mile in their patient's shoes...

Hi lovebug,

I get trigger point injections with lidocaine and steroid all over my back, and I get paravertebral and intercostal nerve block injections with lidocaine and steroid for the front of my torso--the back and front injections help tremendously!!

A regular MD, who works for my MS specialist, gave me the trigger point injections for my back, and an anesthesiologist, who specializes in pain management, gave me the paravertebral / intercostal nerve block injections for the front of my torso (which were actually given on the sides of my torso).

Because there is a small risk of pneumothorax (collapsed lung), fluoroscopy might be used to help guide the needle to just under/behind the rib where the intercostal nerve is located (this is called "walking off the needle") for the paravertebral / intercostal nerve block injections. I can actually feel the pressure when the needle is "walked off" my ribs, but this does not cause pain --I urge you to remain still when this is being done!

All these injections last from six to eight weeks for me; your mileage may vary. One drawback about these injections is there's a limit on how much steroid can be given per injection and per year. The lidocaine is short-acting so that the needle can enter without pain; the steroid is long-acting and is what actually helps stop the MS Hug pain.

I still need to add this information to my first post. These injections are saving me from jumping off a bridge. I hope the injections help you, lovebug. Please let us know how you make out with them and what you learn! Thx!

Edit:



The intercostal nerve, which is the small yellow dot, is easier to see in the bottom depiction.

Picture in your mind the doctor feeling, with his/her finger, the bottom edge of your rib, then pushing in the needle at that location, then by using tiny increments, "walking off" the point of the needle until it reaches just under the curve of the rib bone but not too close to nor into the nerve itself. Use of fluoroscopy can also help guide the needle. Clinical experience counts.

Hope this helps.

Hey HAPPYPOET Thank you so much for your e-mail about the injections. I am photocopying your e-mail and taking it with me when I see the Anaestiologist in May. Any idea about what can be done for numbness, pins and needles feeling in my arms to my hands. Maybe I have HOPE here..............

bunch of psychopaths really .

Hey LOVEBUG, yes, you can have HOPE.

erinc, yep, I'm convinced that's what my EX-neurologist thought.

lovebug, here are some examples of medications that might help numbness and pins and needles:

NSAIDs (Non-steroidal anti-inflammatory meds): Ibuprofen (Motrin, Advil); Naproxen (Aleve).

Tricyclic antidepressants: Amitriptyline (Elavil); Nortripyline (Pamelor).

Anti-seizure meds: Gabapentin (neurontin); Pregabalin (Lyrica); Carbamazepine (Tegretol).

Narcotic opiates: Morphine, oxycontin, methadone, Vicodin, Lortab.

Other possible treatments include chiropractic and home remedies.

HAPPYPOET I have tried almost ever one of those drugs besides Methadone with nooooooooo help for nerve pain. I am beginning to feel like I am some kind of `freak` when it comes to these drugs. I feel like there is something in me that prevents pain relief from nerve paIn. Now does that sound nutty!!!!!!!!!!

What home remedies do you suggest? I have tried Magnesium Glycinate and Boswellia. Not much help there either.

I went to a Pain management class today at a pain clinic and I started talking about finding out more information about block injections. Nobody had even heard of this yet!