Am I having a MS flare?

Question:
I have MS for years but it hasn't been active. My first flair was 3 years ago when I experienced optic problems and lost vision. I saw my neurologist a few weeks ago and all is fine. I take two Lyrica pills (25mg) in the morning and two at night. How long does this take to work? Also for 2 days I have had a lot of pain in my right leg and arm, pins and needles, and burning sensations. I normally have slight neuro pain for the past two days it has been bad. Should I worry that it is another flair?

Answer:
It is sometimes difficult to determine if someone is having a Flare or relapse of their MS. The general rule of thumb is the following:

Relapses cause negative symptoms: Negative symptoms mean a loss of function such as the time you experienced optic neuritis and lost vision. Loss of function symptoms could include loss of strength in a group of muscles, loss of normal movement in an eye causing double vision, or loss of sensation

Recovery from relapses or MS symptoms related to prior scars typically produce positive symptoms: When I say, “positive symptoms” I am NOT implying these symptoms are good for you. "Positive symptoms” refers to the generation of abnormal sensations or movements. These sensations may be tingling, burning, electrical, creepy crawly, itching or a tight band and can be quite annoying. 

Often there is a mixture of negative and positive symptoms during a relapse but it is the negative symptoms that determine the nature and characteristics of a relapse. Positive symptoms are often worsened by elevated temperatures, infections, some medications, other medical conditions,stress and lack of sleep so you have to manage these problems as well.

We use medications like lyrica to reduce or eliminate these abnormal sensations (or positive symptoms) and it sound like it is not doing the trick for you. You can ask your doctor to adjust the dose or consider alternatives such as carbamezipine, oxcarbezipine, lamotrigine, or phenytoin. The Lyrica should have started working by now but you are still on a low dose.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego