An “MS hug” is an unpredictable and often frightening symptom experienced by many people with multiple sclerosis. The MS hug typically feels like a very strong and sometimes painful squeezing around the torso, although the types of sensations it causes, the severity, and the duration, can all vary greatly.
Various factors may be involved with the MS hug. It may be caused by damage to the nerves, by a muscle spasm occurring with muscles found between the ribs, or by common triggers for multiple sclerosis symptoms, such as overheating, stress, fatigue, or illness and infection. Treatments can include medications, various “home remedies” (wearing tight or loose clothing, applying heat, using relaxation techniques, etc.), and lifestyle changes to minimize its occurrence.
Although seldom documented in medical journals, an unpredictable and often frightening symptom referred to as an “MS hug” is a well-known occurrence among a number of individuals with multiple sclerosis (MS). For some, the MS hug can be the initial symptom of MS. And as with so many symptoms of multiple sclerosis, the types of sensations it causes, the severity, and the duration, all vary greatly.
Generally speaking, the MS hug feels like a very strong and sometimes painful squeezing around the torso – sometimes so strong that it may feel difficult to take a breath. This sensation may last for a few seconds, minutes, or hours. While less commonly reported, some individuals may experience this sensation to some degree for a much longer period of time, ranging from days to months. An MS hug is temporary and does not pose any long-term dangers to one’s health, nor does it suggest that one’s multiple sclerosis is worsening.
The MS hug falls under the category of “dysesthesia,” meaning an “unpleasant abnormal sensation” in Greek. Many people describe this sensation as a tightening, girdling, or banding, with the pressure and pain wrapping around the body. Other descriptions can include: crushing; dull, sharp, or stabbing pain; numbness; tingling, tickling, or pins and needles; crawling sensations under the skin; the feeling of burning hot or cold; and vibration.
Various factors may be involved with the MS hug. Dysesthesia in multiple sclerosis is caused by the immune system’s damage to the protective covering to the nerves, and to the nerves themselves, within the central nervous system (CNS). Whenever impulses are interrupted and unable to flow normally between the brain, spinal cord, and other parts of the body, related functions and sensations are altered. Numbness and tingling as well as muscle spasticity are examples of the many symptoms that can result from damage to the nerves of the CNS.
Another component involved in an MS hug is a muscle spasm occurring with the “intercostal muscles,” which are those muscles found between the ribs, holding them in place and helping to move the chest when breathing. Spasms in the muscles around your ribs can cause uncomfortable sensations of tightening and squeezing.
Additionally, the same triggers that cause one’s multiple sclerosis symptoms to temporarily worsen may also trigger an MS hug. These include conditions such as overheating, being under too much stress, being overly fatigued, or when fighting an illness or infection.
If experiencing this symptom for the first time, individuals should inform their doctor so an assessment of its origin may be made. However, if symptoms are severe, individuals need to contact their physician immediately – and seek emergency assistance if needed – to ensure that it is not a heart attack and to rule out any other serious conditions.
Symptoms similar to an MS hug may also be caused by other health issues. These include inflammatory conditions, such as transverse myelitis (inflammation of the spinal cord) and costochondritis (inflammation of the cartilage that connects the ribs), as well as other health issues such as gallbladder problems, lung disease, gastroesophageal reflux disease (GERD), anxiety, and shingles. While an MS hug often appears on its own and is not a sign of the worsening of one’s multiple sclerosis, if other symptoms flare-up at the same time, this may indicate that an individual is having an MS relapse.
Several treatment options are available for an MS hug. One’s physician will need to determine the cause in order to recommend the specific type of treatment – and often this may require trying different medications and strategies to find what works best for an individual’s specific symptoms.
Over-the-counter pain relievers may be of some help if the pain experienced during an MS hug can be attributed to muscle spasms. However, if the discomfort is caused by the interruption of nerve impulses, this is a neurologic type of pain, which means that over-the-counter pain relievers may not be of much help. The classes of medications used in multiple sclerosis for neurologic pain include antispasticity medications, anticonvulsant medications, and antidepressant medications. Certain medications used to treat neuropathic pain in diabetes may also be tried, and while not approved specifically for pain with multiple sclerosis, these may be used “off-label.”
As noted earlier, consulting a doctor is essential if the MS hug is particularly painful or long-lasting. Doing so can rule out other conditions – an important step since one study found that people with multiple sclerosis “commonly misattribute symptoms, including those of serious medical conditions, to the ‘MS hug.’” (Wingerchuk D, et al. The “MS Hug”: Definition, Characteristics, Course, and Misattribution Risk. Neurology, April 9, 2019; 92 [P5.2-111]). Seeing a doctor will also determine if an individual is experiencing a multiple sclerosis relapse. If the latter, corticosteroids may be used to manage the relapse, potentially reducing its severity and duration.
Several home remedies may also be tried to help reduce the intensity of the pain or help the body to “translate” the sensation into a pain-free feeling of pressure. Much of these “remedies” are specific to each individual. For example, some people find more comfort in wearing loose clothing when experiencing the pressure or pain of an MS hug, while others may get some relief by wearing tight clothing, wrapping the affected area, or wearing a pressure stocking. Applying heat to the affected area or taking a warm bath may be of help for some, but others may respond negatively to the added heat. Many people may benefit from relaxation techniques, including meditation, yoga, and deep breathing.
Lifestyle changes may also help minimize the severity of an MS hug and possibly help prevent future ones. Generally speaking, practicing a healthy lifestyle – by avoiding stress, staying proactive in treating an infection or illness, eating a balanced diet and drinking enough water, staying cool, and getting plenty of rest – all may help prevent or minimize an MS hug.
Editor’s note: The details provided in this article are for informational purposes only. Readers are strongly urged to see their physician before making any changes to their treatment regimen.
Written by Susan Wells Courtney, MSAA Senior Writer and Creative Director Reviewed and edited by Barry A. Hendin, MD, MSAA Chief Medical Officer
