Dysesthesia is a type of chronic pain triggered by the central nervous system (CNS). It’s commonly associated with multiple sclerosis (MS), a disease that causes damage to the CNS.
Pain doesn’t always enter the discussion when talking about MS, but it’s actually a common symptom.
Dysesthesia often involves sensations such as burning, electric shock, or a general tightening around the body. It generally occurs in the legs, feet, arms, and hands, but it can affect any part of the body.
The types of dysesthesia include scalp, cutaneous, and occlusal.
Scalp dysesthesia, also called burning scalp syndrome, involves pain, burning, stinging, or itching on or under the scalp. There is usually no rash, flaking, or other visible irritation.
Cutaneous dysesthesia is characterized by a feeling of discomfort when your skin is touched.
The symptoms, which can range from mild tingling to severe pain, may be triggered by anything from clothing to a gentle breeze.
Occlusal dysesthesia (OD), also called phantom bite syndrome, is discomfort in the mouth when biting, usually with no obvious cause.
Although OD was initially believed to be a psychological disorder, a
Dysesthesia vs. paresthesia vs. hyperalgesia
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 increased sensitivity to painful stimuli.
Dysesthesia is more severe than paresthesia and has no apparent stimuli.
Dysesthesia can be intermittent or continuous. The sensations can be mild to intense and may include:
- aching or throbbing
- skin crawling
- burning or stinging
- shooting, stabbing, or tearing pain
- electrical shock-like sensations
The pain and strange sensations associated with dysesthesia may be due to sensory nerve damage. The incorrect signals from your nerves can cause your brain to stimulate strange sensations.
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.
When you have burning or itching, you might usually reach for topical treatments. But because there’s no real issue with your skin or scalp, that won’t help with dysesthesia.
Treatment is different for everybody. It may take some trial and error to find the best solution for you.
Over-the-counter pain relievers such as acetaminophen (Tylenol) and ibuprofen (Motrin) usually aren’t effective for treating neuropathic pain like dysesthesia, according to the National Multiple Sclerosis Society. Neither are narcotics or opioids.
Dysesthesia is usually treated with the following medications:
- antiseizure agents, such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and phenytoin (Dilantin), to calm the nerves
- certain antidepressants, such as amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin), to change your body’s response to pain
- topical pain-relief creams that contain lidocaine or capsaicin
- the opioid tramadol (Ultram, ConZip, Ryzolt), rarely prescribed and usually only for people experiencing severe pain
- the antihistamine hydroxyzine (Atarax), for people with MS, to relieve itching and burning sensations
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.
Even if it’s due to dysesthesia, scratching at your skin or scalp may break the skin. To heal the area and avoid infection, you may indeed need a topical treatment.
More than half of people with MS experience pain as a significant symptom. About 1 in 5 people with MS who report continuous pain describe it as a burning pain that mostly affects their legs and feet.
MS causes the formation of scar tissue, or lesions, in the brain and spine. These lesions interfere with signals between the brain and the rest of the body.
One common type of dysesthesia experienced by people with MS is the MS hug, 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.
Here are some other reasons a person with MS might have strange sensations or pain:
- spasticity (muscle tightness)
- injection site reaction or side effects of medication, including disease-modifying drugs
- bladder infection
Of course, your symptoms could be completely unrelated to MS. They could be due to injury or another underlying condition.
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 you and your doctor find the right treatment, you’ll experience dysesthesia less frequently.
Dysesthesia isn’t unique to MS. Among the other conditions that affect the nervous system and may cause dysesthesia are:
- diabetes, due to nerve damage caused by chronic high glucose levels
- Guillain-Barré syndrome, a rare neurological condition in which the immune system attacks and damages part of the peripheral nervous system
- Lyme disease, which can cause neurologic MS-like symptoms, including itching and burning sensations
- HIV, due to resulting peripheral sensory and motor nerve disorders
- shingles, when tingling and pain occur near lesions
There is growing evidence that natural treatment approaches to chronic pain, such as acupuncture, hypnosis, and massage, may be beneficial.
The following natural remedies may help relieve the chronic pain associated with dysesthesia:
- applying a warm or cold compress to the affected area
- wearing compression socks, stockings, or gloves
- performing gentle stretching exercises
- using lotion that contains aloe or calamine
- taking a bath before bedtime with Epsom salts and colloidal oats
- using certain herbs, such as Acorus calamus (sweet flag), Crocus sativus (saffron), and Ginkgo biloba
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
- isolation from avoiding social outings
- irritability, anxiety, or depression
If your dysesthesia symptoms are interfering with your life, you should see your primary care physician or a neurologist. Other causes for your pain should be examined and ruled out.
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.