What is the MS Hug / Girdle Pain / Girdle Pain Sensation / Squeeze ‘O’ Death?

by Sara on April 29, 2011

What is the MS Hug?

Grey’s Diagram Of The Body’s Intercostal Muscles

Lately I have had serious trouble with something frequently called the MS Hug (also known as Girdle Pain or sometimes Girdle Band Sensation). What is the MS Hug? There are a couple of theories  on what causes this. One theory is that it is just muscle spasms like all the other muscles spasms experienced by people like me. And by “muscle spasms” I mean awful unbearable crippling pain (OK it’s not this bad every single time). The more popular theory is that the spasms are caused  by lesions on the spinal cord – I’ve never had an MRI on my spinal cord so I can’t tell you if that could be a factor for me. It can be an exacerbation or a psuedoexacerbation. In my case I’m not sure. But I’m going to try to give you all the information I can about this abomination. Please remember, I work with computers and have no medical background.

My first experiences with this were extremely painful, but slowly I determined that caffeine, stress, and heat were triggers for all of my muscle spasms, especially the ms hug. I cut out caffeine altogether, tried to use yoga and perspective to control my stress, and I try very hard to stay out of the heat. It can hurt for a few seconds to several weeks. It can hurt a little or can be so painful that I end up in the ER because intravenous Valium is my only hope. Sometimes, even that doesn’t help. The pain can be unreal. It can be unbearable. It can be so bad that you do not wish to live through it. My recent episode was the worst it has ever been and drove my blood pressure to incredible heights.

This particular episode lately was triggered immediately by the stress of Novartis telling me that my insurance company had refused to cover any Multiple Sclerosis medication due to cost. Just to be clear, we pay for the highest level of insurance just to make sure we have the maximum amount of coverage and there are no prescription price limitations on our plans.

There are different types of pain. When I talk to my husband about it, I refer to them as “flavors” of pain. But technically speaking, neurologists will usually call this a “parasthesia” which means that it’s an abnormal sensation caused by neuropathic pain. To me, this makes no sense. When I randomly feel like a grease fire is on my hand that is an abnormal sensation caused by my brain. The MS Hug, or perhaps let’s call it the “MS Grip Of Death” clearly involves pain that is caused by muscles gone nuts, even if they have gone nuts because there are wonky nerves between the brain and muscles.

My daily treatment, per doctor’s orders, went something like 10 10mg of Valium per day, spread out over 5 doses of 2 pills each. Up to 6 7.5mg Loritab per day, sometimes 10mg Cyclobenzabrine, sometimes 0.125mg Hyoscyamine, sometimes 2mg Hydromorphone.  Between 2 ER visits I was given mostly Valium, Solumedrol, and Morphine. After finally believing I had beaten this episode of the hug, the pain would return and I would have to take pills again. When the exacerbation finally ended, I stopped taking the pills altogether. Normally, I can feel the hug coming on, take a couple Valium and it will go away. At worst, it comes on full force, I take some Loritab as well, or maybe Ambien and I’m better in the morning. Or perhaps I may be on a couple Valium a day for a few days in a row. This was far worse than my previous experiences with this symptom.

I was not prepared for the fact that I would have to go through opiate withdrawal from this episode. It has been extremely difficult, to say the least. It brings back the darkest parts of my life in full color or just leaves me with the blackest possible mood for no reason. Every stupid thing I have done, everything I have done to ever feel guilty about haunts me – from fights with my family to being hurtful to former friends. Every instance where I’ve let a friend take advantage of me or abuse me replays over and over. After a few weeks, I think I’m finally past it and hope to never, ever have to go through either the hug or the withdrawal again.

So, what is this MS Hug thing?

The MS Hug involves some or all of the intercostal muscles going into spasm – these muscles hold your ribs together and make your torso flexible. The image at the top of the blog post shows these muscles – the most important thing to remember is that they are located around the abdomen and are largely in between the ribs. Maybe this is different for everyone, but for me it typically starts on one side and at worst ends up wrapping completely around me from just underneath my breasts to the top of my hips. My muscles often feel like river pebbles to the touch. Clothes get tight because the muscles push out, but the muscles also push in, so vomiting ensues and I can barely breathe more than small gasps of air. You may ask if this is a stabbing, throbbing, or squeezing pain. It’s all of the above. The most common description is that you’re being squeezed or crushed to death.

MS Hug Severity Chart

I have heard that Dr. Oz spoke about this in the past on the Montel Williams show. From what I understand he stated that this was the most common cause of death for those suffering from MS – suffocation from the MS hug. To the best of my knowledge this is completely untrue – there are no reported deaths (that I can find) from suffocation due to the MS hug. However, as high as my blood pressure rose from the pain, I don’t doubt that it could put you in a life threatening situation under certain circumstances. Suffocation? No. Feeling like it? Yes.

The intercostal muscles fill up the spaces between the adjacent ribs. They are arranged in three sets, external, internal and innermost internal, eleven pairs of each.

There are three principal layers

  1. External intercostal muscles, which aid in quiet and forced inhalation. They originate on ribs 1-11 and have their insertion on ribs 2-12. The external intercostals are responsible for the elevation of the ribs, and expanding the transverse dimensions of the thoracic cavity.
  2. Internal intercostal muscles, which aid in forced expiration (quiet expiration is a passive process). They originate on ribs 2-12 and have their insertions on ribs 1-11. The internal intercostals are responsible for the depression of the ribs decreasing the transverse dimensions of the thoracic cavity.
  3. Innermost intercostal muscle, the deep layers of the internal intercostal muscles which are separated from them by the neurovascular bundle.

Both the external and internal muscles are innervated by the intercostal nerves and are provided by the intercostal arteries and intercostal veins. Their fibres run in opposite directions

All muscles are in a constant state of readiness (tonus). Although muscles work in pairs and groups to create movement a muscle can only contract (pull) while the opposing muscle relaxes. However, tension is always maintained in both muscle pairs (tonus) to maintain stability.  Tension maintained in the relaxing muscle prevents the contracting muscle from overreacting. When the nerve impulse to the muscle, or muscle group are interrupted the relaxing muscle or muscle group receiving the nerve impulse to maintain its opposing tension will no longer work to maintain the equalizing balance and its opposite partner will then over-react causing the symptoms known as MS Hug.

MS Hug Treatments

MS Hug Treatments

Here are some ideas for alternative therapies to end the pain from an active hug (and my take on them) from what I personally believe to probably be most effective to least :

  • Loosen Your Clothing (Yes. Or just lose it altogether. Seriously. With over 75% of MSers being women, I’m just gonna say take off your bra, hands-down. Men reading this will probably agree, but not necessarily for the same reason)
  • Warmth (A heating pad helps, except when the cats demand it back and I wake up with cat scratches all over my stomach. A hot bath helps sometimes, and sometimes not.)
  • Fluids (Maybe – I’ll just throw it right back up. Better than dry heaves? Although if the pain is not too bad, it’s sweet when Will makes hot chocolate for me – it’s like a heating pad on the inside)
  • Pressure Or Massage To  The Affected Areas (I can usually only tolerate this on my back – the pain is too great anywhere else.)
  • Ibuprofen (HAHAHAHA – no. This started for me when I was already on 80 mg of Baclofen per day for spasticity, so that never helped me. Valium (Diazapam), sometimes mixed with Loritab (Hydrocodone) is my only solution. Unless you’re very much not like me at all. I have Lyrica, but I haven’t had a chance to try it yet. I have also heard of Lorazepam, Xanaflex, and Neurontin. Botox is a newly approved treatment. Anecdotal evidence suggests that marijuana helps with all muscle pain, other pain, and lots of other MS problems.)
  • Analgesic Creams: (This sounds like a joke, but who knows.)
  • Deep Breaths Through The Nose, Exhaled Through The Mouth (Who can breathe deeply when you can’t breathe deeply?)
  • Creative Visualizations: Pretend It’s Not Happening Or Is Being Relieved However You Wish (OK – whatever – I started going into shock last time and only stopped shaking for about 20 minutes while the morphine worked – feel free to give it a try though!)

Here’s hoping that if you experience this, that this post will help you understand it better. Or if a loved one is experiencing this, you will understand better what they are going through. The pain can be unbearable, and conventional treatments can be dangerous.

If your treatment involves narcotics, perhaps your experience will be different than mine. Be cautious. Ask questions. Almost all of the drugs that I was on for this episode noticeably affected my ability to breathe even when I was unaffected by the hug.

Be careful and good luck to all.


Have you ever experienced the MS Hug?

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{ 38 comments… read them below or add one }

Juli June 18, 2012 at 9:15 PM

Dear Sara,

I just wrote you a long email and the internet ate it. I get almost exactly the same type episodes as you have described. Thank you for sharing your experience. NO ONE has spoken about this severe form of the hug and I have read a lot and been on websites. I get the blood pressure spikes too and have had many visits to the ER some by ambulance. It is terrifying. In addition I get paralysis in the rest of my body when it happens….

The positive thinking advice in the chat rooms (one woman told me to try jogging and I was using a power chair at the time) is enough to make one feel crazy. And this is only one aspect of MS. It certainly is one of the scariest.

My cat and I fight over the heating pad. Heat, not enough sleep and stress are my triggers. I was having these episodes so badly three years ago I lost 60 lbs. in 2 mos. and really did have one foot in the grave. No one tells you about the agony — only the disability and maybe numbness and tingling and fatigue.

I look totally normal right now. Even my GP tells me how great I look (I look way younger than 54). I just bite my tongue and tell him he looks marvelous too…I’ve had this since I was 11. It’s maddening sometimes.

My husband read this and said Yup, that’s it…He has been with me during every ER trip. Thank god. And this is just ONE aspect of MS. Let’s not even talk about short term memory or lack thereof.

Thank you so much for being so articulate about what happens during your attacks…flare and exacerbation are too nice a word for it. And as you know, there is so much MORE that goes with it.

This was so validating to read. I can’t tell you how much relief I felt to read these symptoms in print. I feel exonerated somehow and a little less freakish.

I hope to hear back from you but imagine you will get tons of mail about this. Thank you again. Ativan and Lortab work for me too but the attacks require IV Demerol and Ativan…large amounts…I watch cartoons on the ceiling for awhile.

peace love and wellness to you

Juli Michaud


Sara June 19, 2012 at 10:14 AM

Cats really can be selfish over heating pads!

Thanks much for your comment – it makes me so happy that this article has helped you in some way. You are so very right that it’s hard to find any real information about the MS Hug. Even neurologists (even MS specialists) don’t truly understand the experience. They are aware that it’s a “tightness around the chest area” but that doesn’t come close to describing it!

Avoiding caffeine has probably been the best thing I’ve done to prevent these, but some days the hug just randomly hits me for no reason at all. I mentioned this is my last post, but I keep diazepam (Valium) and hydrocodone (Loritab) on me at all times just in case it hits.

Luckily, we live so close to a hospital that I’ve been able to avoid the ambulance. However, when it happens I’m sure you know that there’s no chance at all of successfully driving a car. I’m very grateful that my husband has always been there for me, no matter what hour, to help me.

I sincerely hope you continue to find ways to relieve this. I enjoyed hearing from you!


Nene September 14, 2012 at 3:02 AM

Hi from Australia!
I have suffered (& I mean suffered!!) from this symptom since an MS attack 3 months after my daughter was born in Jan 1999.No Drs including my (excellent)Neurologist knew what it was.Eventually after trips to pain clinics & many doses of Oxycodone I met a pain specialist who put me on morphine sulphate sustained release.Of course,these drugs are monitored very closely here & I have maintained a dose of 75mg per day for over 10 years.Smetimes the pain is so bad that I will allow myself to take an extra tab with some Ibuprofen+Codeine (called Neurofen Plus here.I have just discovered the relief from heat packs you mentioned which I had previously avoided due to heat making my MS symptoms worse.I am presently searching the internet to try & buy clothes that I can wear without discomfort as I`m off on holidays with my husband & 2 children & it`s not really practical to wear night dresses all day as I do at home.I have put on a considerable amount of weight which my Drs are nagging me to lose-ironic as the drugs they prescribe)incl my psychiatric ones)are known to cause weight gain & I really cannot do my daily walk as I did for years & was an ideal weight.After all that about me, I just wanted to tell you that your explanation & advice re the intercostal muscles etc is brilliant-the best I`ve read in my never-ending search for more info about this dreadful symptom.I am going to print it for my Neurologist & other Drs to read.Thank you so much & I wish you a long break from the dreadful “grippies”


Sara September 14, 2012 at 1:18 PM

So glad the article was helpful! I am amazed at how few neurologists seem to understand much about “the hug.” It can truly be so awful – my heart goes out to you for how much you’re living with. As for clothes, I tend to buy lightweight, loosefitting, soft clothing just in case. When it is very bad, I’ll go straight to very soft, very lightweight pajamas as anything remotely tight around my middle makes everything feel so much worse. I hope you find something you like for your trip and have a fantastic time!


Shirley December 29, 2012 at 4:30 AM

Mine is perminently there, I suffer daily with it, it is worse on my left side at the moment and that’s where they doind the possible beginnings of a spinal lesion two years ago on a MRI, haven’t had one scince,I am on Lyrica which has no effect whatsoever on the girdle (hug is not right). Thanks for your post, it helps me a bit reading it.


Sara December 29, 2012 at 7:18 AM

Thank you for your comment, Shirley. I’ve heard of others who suffer permanently with this as well, and I am interested to hear more. How severe is your pain and does it fluctuate? Have you found anything that relieves it at all?

I wish you all the best and hope you find something to prevent this.


Shirley December 29, 2012 at 7:40 AM

The pain soes fluctuate yes and heat and stress makes it worse, I have yet to find something to help with it, I have a usless neuro as well so I cannot count on him for help. At the Moment it is bad on one side but less sore on the other, but we r having a really bad heat wave. I will keep you posted.


Sara December 29, 2012 at 7:50 AM

Where are you located? And have you ever tried baclofen? Baclofen didn’t help me, but others have told me that it helped them. It is better for permanent use than diazepam.


Shirley December 30, 2012 at 1:50 AM

I am in Johannesburg and jab not tried baclofin, I doubt my current neuro would let me. But I am changing neuros next year.

baileyryan December 30, 2012 at 9:45 PM

I have to take lorazepam when it gets really bad. For some strange reason it is the only drug that works in that area. I take baclofen for overall spasming. If it is severe enough for a trip to the ER, lorazepam and demerol control the symptoms. It’s awful…


Tara April 9, 2013 at 4:01 PM

Struggling very hard with this. Nicely put. I have chronic pancreatitis so I cannot take any pain meds outside of ibuprofen. No morphine, codeine, nothing. I hate the term MS Hug. Loved your term of “MS Grip Of Death”


Carol Smith April 18, 2013 at 2:40 AM

I was dx’d with MS in 1996. Had my first “hug” about a week ago and it was very frightening, not to mention extremely painful. Bone-crushing painful. I was just watching tv and it startd up. I don’t even know what brought it on. I took a diazepam to help me relax and went to sleep. The next day I was so sore from that nice little “hug” it was hard to move around. I haven’t yet told my neuro about this as I’m having trouble getting an appt to see him. This is a new symptom for me. But it joins a host of other MS symptoms, mainly weakness, spasticity, and fatigue. I agree it is the grip of death. It’s very frightening. Curious to hear what my neuro has to say about it.


Dawn M Kelm April 27, 2013 at 2:38 PM

Thank-you so much. I thought I was going crazy. I am overweight, out of shape. All that I can do is go to work and go to sleep. I only work 3 to 5 hours a day. This MS hug would hit me at work, make it hard to drive home. I take most of drugs listed, because I have D Disk D . I also take drugs for my back .I remember going to my first support group 2001. My first question was what is normal MS ? I now teach the group. Thank- you again Dawn Kelm


debra May 11, 2013 at 1:31 PM

Hi i am 37 years old i have not yet been dx with ms i have a lot of the symptoms including the ms hug at first they said it was my galbladder swelling then it was the i dont know then it was pulled muscles when i jave the ms hug it is on my right side just under my breast on top of the ribs mine are so bad i cant move or breath and it is visible to other people it looks like there is something under my skin that is going to explode please help


Sara May 12, 2013 at 11:35 AM

I’m certainly not a medical professional, but this sounds identical to my experiences with the start of the MS hug. Try to figure out what triggers it and avoid that if possible. In the meantime, if you can find a local MS group in your region, then maybe they can help to guide you to a neurologist that can give you a proper clinical diagnosis. Don’t wait for it to happen again – be proactive. My heart goes out to you. I hope you find the help you need soon!


debra May 12, 2013 at 1:03 PM

I have been dealing with that for a couple of years but it has gotten way worse .i do go to nuero on the 3rd of june i cant wait i know it is a long process but i just wanna know whats wrong with me .i walk around sometimes in a daze i stumble over words ive said all my life ,i forget the littlest things .sometimes i forget how to swallow i never sleep and list just goes on and on thank you so so much for taking your time to listen and respond it means the world to me ms runs on my dads side of the family my grandmother had it my dad had it before he passed away 2 uncles and one aunt.i of course do not want to have it but i would love an answer of why my legs vibrate and i hurt all the time.do you know if a venous angioma is a lession they found one in my head last year when gdoing xrays .i have very baf bilateral. Tmj ivthought that was why my ears sound funny and my face gets shocked all the time any info anyone has would be great and thanks again


debra May 15, 2013 at 1:16 PM

Anyone have suggestions…..u to have the ms hug however i have not yet been diagnosed.ive been told it was my galbladder to a pulled muscle it happens under my right breast in the rib area it looks like a big bubble it tightens up on me and takes my breath i never know when its coming it feels like a bad contraction .i goTo neuro on june 3 i have been having alot of issues at times i feel drunk i catch my self not being able to say certain things i feel like overwhelmed. By the smallest task which is not like me i have had moments. Lately where i just fall out i do not think im passing out because my eyes are open and it dosent last very long but anyway my legs have been killing me i mean so so bad please can someone tell me what to do please….i have a hard time with steps now for sime reason …i can walk up them my legs feel real heavy but i can do it the hard part is walking down????i get so so shaky you can see my legs tremble i just do not know what to do my gp saud he wants to wait on the neuro report mean while. Im in great pain and scared to death my back feels twistes when i sit to go to the bathroom my leds shake so bad i hear a loud noise un my ears my legs feel electric abd my face does too.my hands are so shaky at tine i cant hold things is there anything i can do ubtil june 3…..


karyn walker May 30, 2013 at 4:03 AM

Hi Debra, I was MS? 11 years ago. I was unwell with leg weakness, burning pain, numbness and fatigue. Was sent to a Neuro who sent me for MRI of Brain…….i had 5 Periventular white matter lesions and was told could be early stages of MS but didnt fit the criteria for definate diagnoses as i needed more proof of another attack and another lesion. I had MRI 6 years ago but no more lesions. I was diagnosed with Fibromyalgia 3 years ago because i was getting pain in more places. Im still not convinced i dont have MS as i feel like im gettin worse. I have that feeling under my breast as well and it does feel like a contraction, i have never mentioned it to my doctor but maybe now i will. Would love to here back from you. Im 48 years old


debra May 30, 2013 at 1:43 PM



Sarah July 4, 2013 at 6:19 AM

Thank You! Reading about your experience helps me cope. It gave me validation and hope that this will go away.
All the Best


Terri July 21, 2013 at 1:07 AM

I just found your blog and have really enjoyed reading. It feels wonderful to find someone else who gets it. One of the best things that I’ve found that can help is to know that you have someone who is, at least, willing to try to be understanding. Even if they don’t really get it, just knowing that they want to is nice. In the meantime, I feel the need to share my experience with you. I have never done anything normally…this extends to the way MS has messed with me. I have several areas of my body that suffer from regular muscle spasms. One of them is qualified as getting an MS ‘hug’. However, rather than encircling my body, I get vertical spasms where the pain usually starts around the area of my waist, runs up my side, through my armpit, then starts down my arm. It has gone from as low as my hip to as far as my fingertips. Usually, though, it is from the waist to about my elbow. Breathing is damn near impossible, movement of any kind is excruciating. Most of the time this happens on my right side, but can happen on either side. It has happened on both sides at the same time. These episodes can last for anywhere from one minute to several hours. I haven’t found anything that works to get rid of them with any rate of success, my only hope is that I can live through it (sometimes I don’t know if I’ll make it). This is one area where my children are very good with me…when they know I am having one of these episodes, they are all pretty helpful in trying to help me get through it. Thank you for putting your experiences out for all of us to read.


lynette August 24, 2013 at 8:56 PM

Hi Sara, thanks so much for sharing your experience and knowledge. I have recently been diagnosed with Stage IV metatastic melanoma and mentioned the excrutiating, hot banded pain around my ribs to my cousin who happens to have MS. Straight away she told me about the ms hug. it is really helpful to know that others have been there and done that and share the tips etc. luckily i’ve only had 4 attacks in 3 months so i haven’t progressed to hosp visits or hard core medication yet – have been given lyrica but have resisted taken it so far. thanks again and stay strong.


Kim September 1, 2013 at 9:01 PM

I cannot thank you enough for this post. I have been struggling with this since July 4th and there have been no answers only pain and praying that it wouldn’t happen again today. I have an appointment with my Neurologist this week and we are going to be having a discussion about this and figuring out how to treat it.

Thank you again.


debra September 2, 2013 at 11:09 PM

Hello everyone i dud see the neuro turns out i have two 4 mm lessions on my left frontal lobe and a calcanious cyst. ..the doctor says not MUCH change from last year so they dont feel im at risk of a bleed thank god but what does that mean exactly not much change and they say they dont think i have ms but i have severe migraines no short term memory. I have had the ms hug for years they thought it was my gul bladder there are days i walk around ina daze like im drunk but havent drank a drop some times my hands shake so bad i cant even read my own writing thats if i can hold the pen i have bilateral tmj so my jaw clicks and pops like crazy but i sound like im under water and in holding a sea shell up to my ears all the time and i get shocked in my face from the temple down ..the list just goes on and on i can be sweating bullets and have goose bumps at the same time my back locks up on me i dont ever sleep my legs cramp so bad they bruise the docotors tell me they have never heard of that before my toes cross and cramp til i cry i can walk up steps but going down my legs shake so bad and im always off balance if i close my eyes or its dark and i try to touch like my two hands together its hard for me like i dont mean clap but like if i reach up its hard for one to find the other …i mean i do not know what these symptoms are but ms runs in my family i hope i dont have it but really watching me walk down a hall theb touching my nose and then her rubbing my feet and telling me to remember a sentence and then saying no its not ms what could it be why do i have the ns hug why at times do my legs feel electric from my knees down why when i sit down do my legs shake so bad any suggestions. ….


Celia Partridge October 14, 2013 at 10:34 PM

I am a 73 year old retired female air traffic controller. My eldest son and my brother’s oldest son were both diagnosed with r/r MS in their early to mid forties. My son’s has progressed to continual decline. I have many of the MS symptoms and a brain scan showed a number of lesions, but a spinal tap was clear. I have severe neuropathic pain and Restless Leg Syndrome as well as almost daily occurrences of what has been described by other sufferers as the MS Hug or Squeeze in my chest. It burns as well as squeezes. I also have significant cognitive deterioration and loss of short term memory. I’ve not been diagnosed with MS, I believe because I have very high blood pressure, diabetes, sleep apnea, and have been diagnosed with fibromyalgia, reflux esophagitis and chronic fatigue which have many similar symptoms as well as some others and I’m much older than most patients at diagnosis. I’ve had some symptoms which started in my thirties and forties. The “hug” just started about 3 years ago, but has increased in both repetition and severity. I’ve used most of the medications mentioned as well as vaporizing medical marijuana which lessens my pain more than any of the pharmacy meds. Are there others who are dealing with overlapping diagnoses as seniors?


misty October 29, 2013 at 1:56 PM

ive been struggling with this 6 years now. thanks for the well written article. in case any of yall are interested I made a fb group, called MS Hug fighters and survivors.


robin April 16, 2014 at 10:28 PM

Breathing exercises and singing exercises has given me alot of relief on top of medication of course. I highly suggest the freeing the natural voice book (you can get it used for like 1.00 on amazon).


Miranda BB January 8, 2015 at 1:26 AM

Thank you! Was thinking of trying singing and breathing exercises.


Tracy August 28, 2014 at 10:43 PM

I have been to the er 4 times. I needed oxygen! I also had natural child birth and never cried out. I was just so sure the ms hug is how I will go. Excruciating death grip. I lived in dreaded gear of the next one. I have muscle relxers and gabapentin. Only morphine and demarol, two drugs I had never had before helped. I was call out help! It was the only word I could say. Stress heat and over doing it can trigger. Severe crushing of ribs, no oxygen. The most dreaded of all my symptoms…


Miranda BB January 8, 2015 at 1:07 AM

Wow! I haven’t been dx with MS but I certainly experience this – from my neck to under my ribs especially for several days at a time. Has been monthly but now more often. The pain is excrutiating. I am going to do more research on MS now.


Richard M January 23, 2015 at 4:33 PM

Hello Sara,
Multiple sclerosis is an autoimmune disease where the immune system attacks the body’s own myelin. Myelin the membrane of cells (Schwan cells in the nerves, oligodendrocytes in the brain or spinal cord) that wraps around the transmitting part (axon) of neurons to increase their speed of transmission. These are called myelinated neurons. Most neurons are not myelinated. Pain neurons are not myelinated. So why do MS patients have such a high incidence of pain?
The reason for this is the unusual method by which the body transmits pain. The receptors that activate pain neurons are very simple and respond to much of the same stimuli as touch receptors do. So, a simple touch can cause signals to go to the spinal cord by both touch and pain neurons. In the spinal cord the pain neurons activate a second level of neuron that carries the pain signal to the brain. However, if the touch neurons were also activated they would also send a signal to the spinal cord only they are myelinated so their signal would get their first. At the spinal cord the touch signal activates a small group of neurons that release a morphine-like neurotransmitter that quenches the pain signal from the body before it is transmitted to the brain.
It’s a strange arrangement and it took a long time to figure it out because we scientists were looking for a pain neuron that was only activated by pain. However, this arrangement explains why exercise suppresses pain and may also be the basis of acupuncture’s ability to suppress pain, etc. In addition to the ‘spinal’ pain suppression pathway there is a also a pain suppression system in the brain that originates in areas known as the periqauaductal grey and raphe nucleus. Activation of the central pain suppression pathway probably explains why people don’t know they are injured in an emergency situation of combat. However, this information has made it possible to implant a stimulator in the periaquaductal grey to allow a patient to suppress pain by pressing a button.
Disorders that cause loss of myelin and myelinated neurons, like multiple sclerosis or diabetic neuropathy, are often accompanied by chronic pain. That pain may be triggered by things as simple as pressure (walking), heat (sunlight), or signals from the internal organs.
Having taught 6000+ future physicians, plus thousands of nursing, dental, podiatry, physician assistant and other health care providers I can say that education in these professions is very intense. Sometimes students don’t pick up on things, particularly if they are complicated. In situations like this the correct information can be hard to find and even harder to separate from the incorrect.
Thank you for your efforts!
Richard McCabe, PhD
Teaching Professor of Pathophysiology
ECU School of Dental Medicine


Karen G. May 25, 2015 at 7:05 AM

The HUG was my first experience of intense, chronic pain with MS. It’s been off and on for 10 years. I don’t think it has anything to do with spinal lesions as I don’t have any. The first time it happened my doctor told me I was just “full of shit”. OK, so I dealt with the constipation, but the pain remained for months. I’ve given up traditional bras for a spandex tank top thingy with underwire support or a uniboob/sports bra. Loosing the constriction around my rib cage has definitely decreased the HUG to a dull roar. Thankfully, I’ve yet to experience it 360 degrees or have my breath taken away. Unfortunately it is rare for my rib pain to resolve in a few hours. Until a few years ago, all of my MS symptoms were right sided. The HUG usually presents on my right side between my lower ribs and often includes pain shooting upward into my left shoulder like a burning arrow just so I can’t ignore it.
I haven’t found any medication other than Bextra (which was taken off the market due to heart complications) that even touches my MS pain. Gabapentin/Lyrica cause excess brain fog and vertigo for me use daily, and to be quite honest I never found them to be any more effective than Aleve for neurological pain. Tylenol and Motrin are useless. I’m not able to resort to opiates as I take LDN (low dose naltrexone, an opiate blocker) to deal with my MS fatigue and gait issues. Besides, I’m not sure opiates would work on what I consider phantom pain (unrelenting with no detectable physical cause that comes and goes for no apparent reason). I’ve never noticed a trigger for the pain. I did a full range of ultrasounds, CAT scans, and MRIs only to determine there was “nothing” wrong. Lots of scares … kidney stones, gall bladder, stroke … but the only thing that’s been diagnosed is arthritis in my neck.
Sometimes a warm bath, heating pad, icy hot patches, ice or, if I can get there, sleep will help. I’ve gotten enough balance back so I can ride my bike again and the exercise seems to reduce the frequency and duration of rib pains. Also I’m taking extra vitamin D, krill oil and adding ground flax seed to yogurt or oatmeal daily. A healthy “diet” seems to help minimize my MS pain and general tingling most of the time. I’m assuming staying away from those tasty sugars is mostly reducing overall inflammation. It also reduces the constipation that definitely adds to my HUG pain factor.
Good luck! Sometimes you just have to grin … and bear it.


Sara May 25, 2015 at 11:01 AM

Hello Karen,

Wow – you have my sincerest sympathy for having to endure this in such a chronic way. I recently had another spinal MRI, and it seems like no matter how much they expect to find spinal lesions, they never do. My brain may be covered in scars, but my spine is squeaky clean. The “phantom pain” you were describing is tough to deal with. I tried Gabapentin for that recently, and after a couple of months of being a zombie and gaining a lot of weight I realized that it was not a medication I could take long-term. Thank you for giving some suggestions for what works for you (as much as anything can). Good luck!


Azaelea Prawn June 6, 2015 at 6:12 PM

My first “hug’ experience started with the weird & very painful feeling that I was being stabbed in the back of my head and my upper back, these sensations moved on to being weird pressure on my abdomen leaving me unable to take any deep breathes ( all very frightening). Tried acupuncture with only very short term relief moved on to very low dose some kind of muscle relaxant which I was prescribed in the ER.

Hearing that others experience things like this helps me to convince myself that this is normal with MS and that I relate so that I don’t “freak out” so much.
Thanks for sharing what works – it;s so helpful to have an arsenal of helpful tips against these nasty MS symptoms.


Sherrie June 8, 2015 at 10:36 AM

Lyrica calms those nerves in my rib cage that tightens. Aspercreme with lidacaine works great!


Liana Terry August 9, 2015 at 10:19 AM

Gm, I have the exact same thing and feel your pain….believe me. It is the worst pain imaginable. I cannot believe there are stupid neuros out there that believe MS does not cause pain….what complete idiots. If they ever get MS, they will know….what a shame…they will know we are not lying and drug seeking…sorry, but I have been through hell as I KNOW you have. Thank you for providing a carbon copy of my ms hug pain…I know I am not crazy now…lol. Best wishes and take care.


Kelly September 15, 2015 at 6:34 PM

I have never been diagnosed with MS. I had a similar experience last night and it scared me. I felt as if I had a corset on and it was crushing me. I have heart problems and stomach problems so like I said, to be blunt, this scared the crap out of me. My husband wouldn’t even acknowledge me, totally different issue there, so Iddidn’t go to the hospital. I have an appointment with my cardiologist tomorrow so I am going to talk to him about it. Anything I need to do or watch for or know in case this was the “MS Hug”?


Sara September 15, 2015 at 9:29 PM

Kelly, I am so sorry you are going through this pain and without support from your husband. Hopefully you do not have MS, and unfortunately there is not much advice I can give on the topic. Few neurologists seem to know about it, so I doubt any cardiologist would. If you believe you have other MS symptoms then I encourage you to get a referral to an MS specialist. Best wishes for a positive outcome for you.


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