Pain is one of the most underrecognized yet impactful symptoms of multiple sclerosis (MS). While the condition is often associated with numbness or mobility issues, research shows that more than 50–70% of people with MS experience pain during the course of their illness — and in many cases, it can become chronic. Yet MS pain remains widely misunderstood — not only in where it occurs, but in how it feels, why it happens, and how it changes over time. Why MS Causes Pain MS targets the central nervous system (CNS) — the brain and spinal cord. When the immune system mistakenly attacks the myelin sheath (the protective coating around nerve fibers), it disrupts normal nerve signaling. Depending on where these lesions occur and how they affect communication between nerves, different types of pain can emerge. The three most common categories of MS-related pain include: • Neuropathic pain: Directly caused by nerve damage, this can feel like burning, stabbing, tingling, or electric shock-like sensations. It may occur spontaneously or be triggered by touch, temperature, or movement. • Musculoskeletal (nociceptive) pain: Indirect pain resulting from poor posture, spasticity, or altered gait. Muscle stiffness, joint discomfort, and soreness often fall into this category. • Referred pain: Pain that appears in one area due to a problem elsewhere. For instance, limping may lead to lower back or hip pain due to uneven strain on muscles and joints. Unusual Places MS Pain May Show Up Unlike localized injuries, MS pain is often unpredictable. It may appear in areas that seem unrelated to disease activity: • Face or jaw: Severe, stabbing pain (often from trigeminal neuralgia) can be one of the earliest or most intense MS symptoms. • Chest or ribs: A tightening or squeezing sensation — known as the “MS hug” — occurs when intercostal muscles between the ribs go into spasm. • Lower back: Strain can result from muscle weakness, poor core stability, or long-term compensation for altered walking mechanics. • Neck and shoulders: These areas often carry tension related to fatigue, poor posture, or imbalance. • Head: Some people with MS report frequent headaches, possibly linked to neck muscle tension or central nervous system dysregulation. These patterns make it difficult to explain or localize pain — especially when standard tests don’t show inflammation or visible lesions in those areas. Pain Can Vary Day to Day — Why? Pain in MS isn’t static. It can fluctuate depending on internal and external factors: • Temperature sensitivity: Heat exposure can worsen nerve conduction issues, making pain feel sharper or more widespread (a phenomenon known as Uhthoff’s phenomenon). • Fatigue: As physical and cognitive energy drains throughout the day, the brain’s ability to regulate discomfort often weakens. • Stress and anxiety: Emotional strain can amplify how the nervous system processes pain, sometimes increasing muscle tension and pain sensitivity. • Sleep disruption: Poor-quality or fragmented sleep reduces your pain threshold and increases inflammation, worsening symptoms over time. Evidence-Based Ways to Manage MS Pain Pain management in MS is highly individualized, but several approaches have scientific backing: 1. Physical strategies: • Gentle movement and stretching reduce stiffness and prevent secondary musculoskeletal strain. • Posture and gait training (via physical therapy) can address alignment issues and reduce compensatory pain. • Cooling interventions like cold packs, vests, or fans help those with heat-sensitive neuropathic pain. 2. Medications (under medical guidance): • Anticonvulsants (e.g., gabapentin, pregabalin) • Antidepressants (e.g., amitriptyline, duloxetine) for nerve pain • Muscle relaxants or anti-spasticity agents (e.g., baclofen, tizanidine) 3. Mind-body and behavioral tools: • Mindfulness meditation, which has been shown to reduce pain perception by altering how the brain processes discomfort. • Cognitive-behavioral therapy (CBT) to help reframe pain experiences and reduce psychological stress. • Biofeedback and breathing techniques to regulate the body’s stress-pain response loop. Takeaway MS pain is real — even when invisible, inconsistent, or difficult to describe. It may arise from damaged nerves, altered biomechanics, or systemic factors like heat and fatigue. Understanding its many faces is key to reducing its impact on daily life. If you’re experiencing pain that’s hard to explain, you’re not alone — and it’s worth talking to your care team. The goal isn’t just to “live with it,” but to manage it with tools that work for you. ---------------------------- Youtube: https://www.youtube.com/@traxel11 Facebook: https://www.facebook.com/mytraxel/ Instagram: https://www.instagram.com/mytraxel/ Threads: https://www.threads.net/mytraxel/ LinkedIn: https://www.linkedin.com/company/traxel

Many people with multiple sclerosis (MS) notice that balance becomes more difficult in the dark or low-light environments. Moving at night, walking in poorly lit spaces, or even standing up without light can trigger unsteadiness or a fear of falling. This is a common—and explainable—issue linked to how MS affects the sensory systems that maintain balance. Why Balance Relies on More Than Just Muscles To stay steady and upright, the body depends on three main systems working together: 1. Vision – Provides feedback about the environment and where the body is in space. 2. Proprioception – The sense of body position and movement, relying on nerve signals from muscles, joints, and skin. 3. Vestibular system – Controls the inner ear’s sense of balance and motion. When MS damages nerve pathways (demyelination), the brain may not receive accurate information from the proprioceptive system. In daylight or well-lit conditions, the brain can compensate by using visual cues to stay balanced. But in darkness, that visual information is lost, making any existing sensory or proprioceptive deficits much more noticeable. This can lead to feeling wobbly, uncertain, or even freezing in place to avoid falling. Why Does This Happen in MS? Key reasons balance worsens in the dark with MS include: • Sensory pathway damage – MS lesions disrupt nerve signals needed for position sense. • Delayed nerve transmission – Demyelinated nerves slow down the processing of balance information. • Fatigue – Muscle and nerve fatigue can make coordination harder, especially later in the day. • Reduced compensation – Without visual input, it’s harder for the brain to correct balance quickly. Common Experiences People with MS often describe: • Feeling unsteady or swaying when standing in the dark • Reaching out for walls or furniture for support • Hesitation or freezing before walking in low light • Increased fear of falling at night How It Can Affect Daily Life • Navigating the home at night (e.g., to the bathroom) becomes challenging. • Increased fall risk, especially when getting up from bed or moving quickly. • Sleep disruption due to fear of nighttime movement. • Reduced confidence or independence in unfamiliar environments. Practical Strategies to Improve Nighttime Balance While this symptom may not be completely avoidable, there are many ways to reduce its impact: • Night Lights and Motion Sensors: Place soft lights along hallways, in bedrooms, and near bathrooms to maintain visual cues without disrupting sleep. • Use Walking Aids: Canes or walkers can improve stability. Some have built-in lights or reflective features for safety at night. • Balance and Proprioception Exercises: A physical therapist can develop exercises to improve how the brain processes balance signals—even when vision is limited. • Keep Walking Paths Clear: Ensure floors are free from clutter, loose rugs, or cords that could increase fall risk. • Wear Supportive Footwear or Non-Slip Socks: Provides extra stability, even indoors. • Manage Fatigue and Rest Balance often worsens with tiredness. Plan for rest breaks and avoid overexertion, especially late in the day. When to Talk to Your Healthcare Provider Consult your neurologist or physical therapist if: • Balance issues are getting worse or feel unpredictable. • You’ve experienced recent falls or near-falls. • Balance problems interfere with daily activities or confidence. They may recommend updated therapies, medication adjustments, or adaptive tools to improve your safety and independence. Final Thoughts Balance difficulties in the dark are a real and common challenge for people with MS. While vision often compensates for sensory loss during the day, low-light environments reveal how much MS can affect proprioception and coordination. With practical strategies, support, and therapy, it’s possible to reduce risks and move with more confidence—even at night. ---------------------------- Youtube: https://www.youtube.com/@traxel11 Facebook: https://www.facebook.com/mytraxel/ Instagram: https://www.instagram.com/mytraxel/ Threads: https://www.threads.net/mytraxel/ LinkedIn: https://www.linkedin.com/company/traxel

Some people with multiple sclerosis (MS) describe the unsettling feeling of walking on gravel, marbles, or pebbles—even when the floor is completely flat and smooth. This unusual but common sensory symptom can be confusing, uncomfortable, and even dangerous, especially when it affects balance or walking confidence. This symptom is a form of paresthesia—abnormal sensory input caused by damage to the nerves responsible for detecting pressure, position, and touch. Understanding the neurological cause behind this feeling can help people with MS manage it more effectively and protect their mobility. What Causes the “Pebble” Sensation in MS? TraXel | Pebble Sensation in MS This sensation is usually the result of demyelination—the process in which MS damages the protective coating (myelin) around nerves. When this occurs in the spinal cord, brainstem, or peripheral sensory pathways, it disrupts the brain’s ability to process accurate input from the feet. Instead of registering flat pressure and smooth surfaces, the nervous system may interpret distorted signals, making it feel like there’s something uneven or textured underfoot—even when there’s not. Neurological mechanisms may include: • Proprioceptive distortion – disrupted awareness of limb position and pressure • Tactile signal misfiring – damaged nerves misreport textures or resistance • Localized numbness or hypersensitivity – creates patchy, uneven feedback from the soles What It Feels Like This sensation can vary but is often described as: • Feeling like walking on small pebbles, gravel, sand, or marbles • A sense that something is stuck to the feet or in the shoes • Discomfort or pain despite no visible cause • A mismatch between foot sensation and visual feedback It may be intermittent or constant, and for some, it’s more noticeable after fatigue, prolonged sitting, or during relapses. How It Affects Daily Life This altered foot sensation can: • Disrupt balance and stability while walking • Increase the risk of falls or hesitation • Cause anxiety or reduced confidence with mobility • Make it difficult to judge surfaces (e.g., while walking barefoot, outdoors, or on stairs) Strategies to Manage the “Pebble” Sensation While there’s no instant fix, there are several strategies that can help reduce the impact of this sensation on daily life: - Footwear Adjustments • Use well-cushioned shoes or insoles to dampen abnormal sensations • Try textured insoles or sensory-stimulating socks to help normalize feedback • Avoid barefoot walking if the sensation is triggering instability - Balance & Sensory Retraining • Work with a physical therapist or occupational therapist to retrain the brain’s interpretation of foot input • Exercises may include balance work, gait training, or proprioceptive drills - Protective Strategies • Keep walking paths clear and well-lit • Use handrails, mobility aids, or supportive footwear during symptom flares • Avoid uneven or slippery surfaces during times of heightened sensation - Medical Support • Discuss with your neurologist if symptoms worsen or interfere with mobility • In some cases, medications used for neuropathic pain (e.g., gabapentin or pregabalin) may help reduce sensory distortions When to Seek Help Talk to your healthcare provider if: - The sensation suddenly worsens or spreads - It causes frequent tripping or falling - It occurs along with new numbness or weakness - It becomes painful or constant Final Thoughts The sensation of walking on pebbles in MS is a real and neurologically based symptom, not imagined or exaggerated. While it may be disorienting, awareness, supportive tools, and targeted therapies can reduce its impact and help people with MS stay safe and confident on their feet. ---------------------------- Youtube: https://www.youtube.com/@traxel11 Facebook: https://www.facebook.com/mytraxel/ Instagram: https://www.instagram.com/mytraxel/ Threads: https://www.threads.net/mytraxel/ LinkedIn: https://www.linkedin.com/company/traxel