Dysesthesia is pain triggered by the central nervous system, commonly associated with multiple sclerosis (MS). Pain doesn’t always enter the discussion when talking about MS, but it’s actually a common symptom.

Dysesthesia often involves abnormal sensations such as burning, electric shock, or a general tightening around the body, also called the MS hug. It generally occurs in the legs and feet, but it can affect any part of the body.

Other forms of dysesthesia are oral dysesthesia, or burning mouth syndrome, and scalp dysesthesia, called burning scalp syndrome.

It’s easy to confuse dysesthesia with paresthesia or hyperalgesia, both of which can also occur with MS. Paresthesia describes sensory symptoms such as numbness and tingling, “skin crawling,” or that “pins and needles” feeling. It’s distracting and uncomfortable, but not generally considered painful. Hyperalgesia is an exaggerated response to painful stimuli.

Dysesthesia is more severe than paresthesia and has no apparent stimuli.

Dysesthesia can be intermittent or continuous. About one in five people with MS who report continuous pain describe it as a burning pain that mostly affects the legs and feet. Abnormal sensations can be rather intense and may include:

  • aching or throbbing
  • skin crawling
  • burning or stinging
  • shooting, stabbing, or tearing pain
  • electrical shock-like sensations

It can cause extreme itching of the skin or scalp, though there’s no rash, flaking, or other visible irritation.

The MS hug is so called because it feels like you’re being squeezed around your chest. It can be described as a crushing or vice-like grip causing pain and tightness in your chest and ribs. You can also have these sensations in your legs, feet, hands, or head.

Pain and strange sensations are due to damage in the central nervous system. People with MS form scar tissue, or lesions, in the brain and spine. These lesions interfere with signals between the brain and the rest of the body.

For example, you may have painful sensations in your leg even though there’s nothing wrong with your leg. It’s a communication problem between your brain and the nerves in your leg, which stimulates a pain response. And the pain is very real.

Normally, when you have burning or itching, you might reach for topical treatments. But because there’s no real issue with your skin or scalp, that won’t help with dysesthesia.

If you have disturbing sensations or pain that won’t go away, you shouldn’t assume it’s due to dysesthesia, though. See your primary care physician or neurologist. Other causes for pain should be examined and ruled out.

Here are some other reasons a person with MS might have weird sensations or pain:

And of course, your symptoms could be completely unrelated to MS. It could be due to injury or another underlying condition.

Treatment is different for everybody. It may take some trial and error to find the best solution for you. Medications used to treat dysesthesia include:

  • over-the-counter pain relievers
  • anti-seizure agents such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and phenytoin (Dilantin)
  • anti-anxiety agents such as duloxetine hydrochloride (Cymbalta) and clonazepam (Klonopin)
  • tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin)
  • tramadol (Ultram, ConZip, Ryzolt), especially for burning sensations
  • lidocaine or capsaicin patches
  • the antihistamine hydroxyzine (Atarax)

Your doctor will start you out on the lowest possible dose and adjust upward if needed. Before starting on a new medication, ask your doctor about all the potential short- and long-term side effects. To avoid dangerous drug interactions, tell your doctor about all the medications you take.

Additional techniques that may help are:

  • meditation and deep breathing exercises
  • wearing a pressure stocking or glove
  • warm or cold compresses

Even if it’s due to dysesthesia, scratching at your skin or scalp may have broken the skin. You may indeed need a topical treatment to heal and avoid infection.

Persistent dysesthesia can interfere with your life in a number of ways, such as:

  • skin or scalp irritation or infection due to scratching or rubbing
  • daytime fatigue due to poor sleep
  • inability to perform everyday tasks
  • avoiding social outings, which can lead to isolation
  • irritability, anxiety, or depression

Dysesthesia isn’t unique to MS. Among the other conditions that may cause dysesthesia are:

Like other symptoms of MS, dysesthesia can come and go. It can also completely disappear without treatment. Also like many other symptoms of MS, when the overall disease is controlled, you’ll experience dysesthesia less frequently.

Dysesthesia doesn’t always require treatment. But if you seek help, there are a variety of options to manage it and improve your overall quality of life.