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
- 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 -
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.
like drops of rain
until the day
came higher April rays
and dried our tears
Post Script: Invasive Treatments
and Opiod Medication