Pain relief in multiple sclerosis is one of the most important topics when it comes to improving quality of life. This article is a translation of the original German interview published in January 2025.
Pain is one of the most common and most burdensome symptoms in multiple sclerosis, which is why pain relief is an important topic to increase quality of life. But what exactly triggers this pain, and what options are available to treat it effectively?
In this interview, neurologist and pain therapist Dr. Camelia Ionescu shares her comprehensive knowledge about the complex mechanisms of MS-related pain and explains how a multimodal approach consisting of medication, physiotherapy, and psychological support can help those affected.
You will also learn which alternative methods are promising, how patients can strengthen their self-empowerment, and what progress she hopes to see in pain therapy in the future. You will gain insights and practical tips to improve quality of life despite chronic pain.
Note: This content is for informational purposes only and does not replace professional medical advice.
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More InformationTable of Contents
Introduction – Who is Dr. Camelia Ionescu?
Dr. Camelia Ionescu (Neurologist & Pain Specialist): I am a neurologist from Romania and have been working at the Marianne Strauß Clinic in Germany since 2002.
I came here after meeting my future husband in Munich during my medical training. At that time, I was told that my chances of working as a neurologist in Germany would be very low, so it was a difficult decision to move.
The beginning was not easy, but these experiences helped me grow and strengthened my empathy for patients. I understand what it feels like when something seems overwhelming and difficult to manage. But life experience shows: there is always a solution, even if it is not immediately visible.
Nele von Horsten: I find it impressive how your journey shows that personal challenges can enrich medical practice.
Pain Triggers in MS
Which specific factors can trigger pain in MS patients?
Dr. Camelia Ionescu: Pain in MS arises from different mechanisms. Inflammatory lesions in the brain or spinal cord can, for example, cause neuropathic pain. In addition, there are musculoskeletal pains that arise from altered posture or movement patterns. Interestingly, specific lesions in areas such as the periaqueductal gray in the brainstem can trigger headaches. The chronification of pain through immunological processes also plays a role.
Nele von Horsten: That is an important perspective because many patients often do not know that their pain is caused by MS and not by something else.
Could you briefly explain what neuropathic pain is?
Dr. Camelia Ionescu:
There are three main types of pain: nociceptive pain, neuropathic pain, and nociplastic pain.
Pain signals are transmitted through the somatosensory system, which includes nerve fibers and pathways that carry signals to the spinal cord and brain. However, pain is always processed and perceived in the brain.
Pain perception is influenced not only by current lesions, but also by genetics, early life experiences, and previous pain experiences.
If nociceptors (pain receptors) are activated, we speak of nociceptive pain. If the nerve pathways themselves are affected, it is neuropathic pain. If neither tissue damage nor nerve damage can be identified, but pain persists, this is called nociplastic pain.
In such cases, pain can become a disease of its own, even after the original cause has healed.
Are there triggers that vary individually?
Dr. Camelia Ionescu:Yes, triggers vary from patient to patient. Stress is a frequently mentioned factor, as well as comorbidities or genetic influences. Everyone experiences pain differently, which makes a personalized approach necessary.
Medication-Based Approaches
Which medication options are available to treat MS-related pain?
Dr. Camelia Ionescu: In multiple sclerosis, immunological treatment plays a very important role, because it helps prevent new lesions or reduce their occurrence. These lesions can also be associated with pain.
There is a broad range of medications. In addition to classic painkillers such as non-steroidal anti-inflammatory drugs and opioids, we also use antidepressants that strengthen pain-inhibiting pathways in the central nervous system. Newer options such as capsaicin patches are also promising. In acute inflammatory relapses, corticosteroid pulse therapies or adjustments to immunotherapy are used.
How do you choose the most suitable medication for a specific patient?
Dr. Camelia Ionescu: That depends on the type of pain, comorbidities, and individual preferences. Side effects and cognitive impairments also play a role. The choice is made in close coordination with the entire therapeutic team.
Therapeutic Approaches
How can physiotherapy and other therapeutic approaches be integrated into multimodal pain therapy?
Dr. Camelia Ionescu: Physiotherapy is essential. After a comprehensive assessment by physicians, physiotherapists, and occupational therapists, we create individual treatment plans. These include exercises to maintain mobility and muscle strength, as well as physical measures such as heat therapy. This is complemented by social and psychological support.
Nele von Horsten: This combination of physical and emotional support certainly makes a big difference in patients’ quality of life.
How important is psychological support in the treatment of pain in MS, and which approaches are often used?
Dr. Camelia Ionescu: Psychological support is crucial, especially in chronic pain. Cognitive behavioral therapy and acceptance and commitment therapy (ACT) help patients cope better with their pain and build resilience.
What role does self-empowerment play?
Dr. Camelia Ionescu: Self-empowerment is a central component of our work. We teach patients techniques such as progressive muscle relaxation or breathing exercises that they can use independently. This strengthens their self-efficacy and improves pain control in everyday life.
Alternative Methods
Are there alternative or complementary methods that show promising results?
Dr. Camelia Ionescu: Yes, methods such as acupuncture, mindfulness-based stress reduction (MBSR), and phytotherapy can have a supportive effect. In our clinic, we integrate these approaches to offer patients holistic treatment.
How are alternative approaches integrated?
Dr. Camelia Ionescu: Alternative methods complement conventional medicine. For example, we teach patients simple applications such as quark compresses or heat packs that they can use at home to relieve their pain.
Quickfire Round
Complete the sentence: “For me, multiple sclerosis is…”
Dr. Camelia Ionescu: …a challenging disease that requires patience, creativity, and collaboration.
Which breakthrough in research and treatment do you hope for in the next 5 years?
Dr. Camelia Ionescu: Better local treatment methods, new medications with fewer side effects, and more specialized pain therapists.
Which website can you recommend on the topic of MS?
Dr. Camelia Ionescu:
International organizations such as the National Multiple Sclerosis Society and the MS International Federation provide reliable information on multiple sclerosis.
For pain management, the International Association for the Study of Pain is also a valuable resource.
Farewell
Would you like to give listeners something to take away?
Dr. Camelia Ionescu: I would like to tell everyone affected: Do not give up! There are always ways to relieve pain and improve quality of life. It can take time, but together we will find the right solution.
Nele von Horsten: Thank you very much, Dr. Ionescu, for the insights and valuable tips. Your work is so important. Thank you!
See you soon and try to make the best out of your life,
Nele
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