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The Beyond Pain Foundation

Conditions we support

Conditions guide

Multiple sclerosis (MS)

MS is a lifelong condition of the brain and spinal cord. It affects everyone differently. For many people, the hardest parts are the ones others can't see: pain, stiff or spasming muscles, and overwhelming tiredness. This guide explains the types of MS, relapses, the treatments available in the UK, and your rights at work.

People in the UK with MS
Over 150,000
Newly diagnosed each year
Nearly 7,100
Women compared with men
Almost 3 times more likely
Disease-modifying therapies on the NHS
Around 20

This guide is general information, not medical advice. Medicines and treatments must be prescribed or recommended for you by a doctor or pharmacist. We do not give doses here.

What MS is

In MS, the immune system attacks the protective coating around nerves in the brain and spinal cord. This coating is called myelin. When it is damaged, messages between the brain and the body slow down or get mixed up. That is what causes the symptoms.

Nobody knows exactly why MS happens. It is thought to be a mix of genes and things in the world around us. It is not passed on directly from parent to child, and you can't catch it.

MS is usually diagnosed between the ages of 20 and 50, though it can start earlier or later. Women are almost three times more likely to get it than men. Around 1 in every 400 people in the UK has MS.

MS isn't curable yet, but treatments have improved a great deal. Most people with MS live into old age, though on average life expectancy is a few years shorter than for people without it.

Types of MS

Doctors describe MS by how it behaves over time. Your type can change, and doctors also say whether your MS is "active" (relapses or new changes on a scan) or "not active".

Relapsing remitting MS

The most common type. About 85 in 100 people are diagnosed with it. Symptoms flare up in a relapse, then get better, partly or fully. On average people have one or two relapses a year, though this varies a lot.

Secondary progressive MS

Many people with relapsing MS later find their disability builds up steadily, with fewer or no relapses. Older studies found about half had moved to this stage after around 19 years. Modern treatments may delay it.

Primary progressive MS

About 10 to 15 in 100 people. Symptoms get gradually worse from the start, usually without relapses. It tends to be diagnosed a little later in life.

Clinically isolated syndrome

A first episode of MS-like symptoms lasting at least 24 hours. Some people go on to be diagnosed with MS, and some never have another episode.

Highly active MS

Relapsing MS with frequent, disabling relapses or a lot of new activity on scans. It is usually treated early with the stronger disease-modifying therapies.

Benign MS

A term sometimes used when someone has had very little disability 10 or more years after diagnosis. It can only be said looking back, and invisible symptoms like fatigue and pain may still be a problem.

Symptoms and relapses

MS can affect almost any part of the body. Common symptoms include fatigue, problems with sight, numbness and tingling, muscle stiffness and spasms, balance problems, bladder and bowel problems, and changes in memory and thinking. Few people get all of them.

Pain

  • Up to 4 in 5 people with MS have pain at some stage
  • Nerve pain: burning, stabbing, electric shocks, pins and needles
  • Lhermitte's sign: a brief electric feeling down the spine when you bend your neck
  • The "MS hug": a tight, squeezing band around the chest or tummy
  • Muscle and joint pain: from stiffness, posture or walking differently
  • Trigeminal neuralgia (sudden face pain) affects 2 to 5 in 100 people with MS

Stiffness, spasms and fatigue

  • Spasms or stiffness affect 40 to 80 in 100 people with MS at some time
  • Spasticity: tight muscles that resist movement, often in the legs
  • Spasms: sudden jerks or cramps, often at night
  • Fatigue: affects around 6 to 8 in 10 people. It is not ordinary tiredness and rest doesn't always fix it
  • Heat, infection, stress and a full bladder can all make symptoms worse

What happens in a relapse

  1. At least 30 days stable

    Before

    A relapse is only counted if you have been stable for at least 30 days since the last one.

  2. Over hours or days

    Onset

    New symptoms appear, or old ones get clearly worse. They must last more than 24 hours, without an infection or other cause.

  3. Days to weeks, sometimes months

    The relapse

    Symptoms are at their worst. Steroids, if offered, work best started early, within 14 days.

  4. Weeks to 12 months

    Recovery

    Most people recover over a few weeks or months. Recovery can be full or partial, and can continue for up to a year.

Timings are typical ranges, not exact rules. Everyone's MS is different.

Is it a relapse or a "pseudo-relapse"?

Symptoms can flare for a short time because of an infection (often a urine infection), being too hot, stress, poor sleep or your period. This is called a pseudo-relapse. It settles once the cause is dealt with. If you aren't sure, contact your MS nurse. Don't wait for a relapse to pass on its own if it is affecting your daily life.

When to get urgent help

Call 999 if you have

  • sudden weakness or numbness in your face, an arm or a leg, especially on one side
  • sudden problems speaking or understanding speech
  • sudden loss or blurring of sight
  • sudden severe problems with balance or co-ordination
  • difficulty breathing or swallowing

These can be signs of a stroke, even if you have MS. Don't assume it is a relapse.

Contact your MS team or NHS 111 if

  • you think you are having a relapse that affects your daily life
  • new symptoms haven't improved after 24 to 48 hours
  • you have changes to your sight or new weakness affecting walking
  • you lose control of your bladder or bowel
  • you have a high temperature or signs of a urine infection

See your GP or MS nurse if

  • pain, stiffness or spasms are getting worse or stopping you sleeping
  • fatigue is affecting your work or home life
  • you feel low or anxious
  • your medicines are causing side effects
  • you haven't had a full MS review in the last year

Diagnosis and referral

If your GP thinks you might have MS, they will refer you to a neurologist. NICE says a GP can contact the neurologist directly if someone needs to be seen urgently. There is no single test for MS. A neurologist puts together:

  • Your history and an examination
  • An MRI scan of the brain and spine
  • Blood tests to rule out other causes
  • Sometimes a lumbar puncture (spinal fluid test)
  • Sometimes evoked potential tests, which check how fast nerves carry messages
  • The McDonald criteria, used by specialists across the world

MS can't be diagnosed on an MRI scan alone. It is common for diagnosis to take several months, and sometimes longer, because other conditions have to be ruled out first.

NICE says that after diagnosis you should have a face-to-face follow-up with an MS specialist within 6 weeks. You should be given contact details for an MS specialist nurse, and have a full review of your care at least once a year.

Disease-modifying therapies

Disease-modifying therapies (DMTs) don't treat symptoms. They calm the immune system to reduce relapses and slow down damage. There are around 20 available on the NHS. They are prescribed by an MS neurologist, not your GP. Most are for relapsing MS, and the earlier you start, the better they tend to work.

Tablets

Prescribed by an MS specialist

Taken once or twice a day, or in short courses. Examples include dimethyl fumarate (Tecfidera), teriflunomide (Aubagio), fingolimod (Gilenya), ponesimod (Ponvory) and cladribine (Mavenclad). Siponimod (Mayzent) is for active secondary progressive MS.

Injections

Usually self-injected at home

Beta interferons and glatiramer acetate (Copaxone) have been used for many years. Ofatumumab (Kesimpta) is a stronger option injected once a month.

Infusions (a drip)

Given in hospital or an infusion clinic

Natalizumab (Tysabri), usually every 4 weeks. Ocrelizumab (Ocrevus) and ublituximab (Briumvi), usually every 6 months. Ocrelizumab is also the first DMT for early, active primary progressive MS. Alemtuzumab (Lemtrada) is given in two short courses a year apart.

Stem cell treatment (aHSCT)

Specialist centres only

Uses chemotherapy to reset the immune system. It is only for some people with very active relapsing MS that hasn't responded to other DMTs. It carries serious risks and needs a long hospital stay.

DMTs take time to work. Some take weeks and others several months to reach their full effect, so you may still have a relapse soon after starting. Your neurologist will check your progress with regular blood tests and MRI scans. Ask how long your DMT takes to work, and what monitoring it needs.

Pregnancy and DMTs

Some DMTs must not be taken during pregnancy, and some need you to wait a while after stopping before trying to conceive. If you are planning a family, talk to your MS team early. Don't stop a DMT without advice.

Treating a relapse

Not every relapse needs treatment. For one that affects your daily life, NICE recommends a short course of steroid tablets (methylprednisolone) for 5 days, started as early as possible and within 14 days. A steroid drip in hospital is an alternative. Steroids help you recover faster but don't change how much you recover in the long run.

Treating pain, stiffness and fatigue

These symptoms are treated separately from the MS itself. Your GP, MS nurse, physiotherapist or occupational therapist can all help. Treatment usually works best as a mix of medicine, therapy and self-management.

  1. Spasticity and spasms

    Physiotherapy first, with medicine if needed

    Stretching, exercise and a good sitting and lying position help most people. Treating triggers like constipation, infections or tight clothing matters too.

    NICE recommends baclofen first, or gabapentin if baclofen doesn't suit you. They can be combined. Other options from a specialist include tizanidine and dantrolene. Doses are built up slowly to limit drowsiness and weakness.

  2. Sativex for spasticity

    A 4-week trial, then continued only if it helps

    A cannabis-based mouth spray (nabiximols) for moderate to severe spasticity when other medicines haven't worked. It is started by a specialist. It is only continued if your spasticity improves by at least 20% after 4 weeks. About half of people in trials reached this.

  3. Nerve pain

    Each medicine needs several weeks at the right dose

    Ordinary painkillers rarely help nerve pain. NICE's neuropathic pain guideline suggests trying amitriptyline, duloxetine, gabapentin or pregabalin, and switching if one doesn't work or causes side effects. Carbamazepine is used for trigeminal neuralgia. Muscle and joint pain is often helped most by physiotherapy, posture and treating stiffness.

  4. Fatigue

    Self-management first, then medicine if needed

    First check for other causes, such as poor sleep, low mood, infection, anaemia or side effects of other medicines. NICE recommends exercise and fatigue management courses that cover pacing, planning and CBT. If these aren't enough, a specialist may suggest amantadine, modafinil or an SSRI antidepressant. None are licensed for MS fatigue, so you will talk through the pros and cons.

What NICE says not to use

NICE advises against vitamin B12 injections or hyperbaric oxygen for MS fatigue, and against fampridine for walking. It also says vitamin D and omega-3 or omega-6 supplements should not be taken as a treatment for MS itself. Ask your MS team before spending money on supplements or private therapies.

Specialist options

If spasticity is severe and tablets aren't enough, a specialist team may suggest:

Botulinum toxin injections

Specialist spasticity clinic

Injected into a few tight muscles to relax them. The effect lasts several months, and the injections can be repeated. Physiotherapy and stretching afterwards help get the most from them.

Baclofen pump

Neurosurgery centre

A small pump placed under the skin of the tummy gives baclofen straight into the spinal fluid. You'll have a test dose first to see if it helps. The pump needs refilling every few months at the clinic.

Electrical therapies

Physiotherapy or specialist services

Functional electrical stimulation (FES) can help with foot drop. TENS machines may ease some pain. Splints, braces and standing frames can help manage stiffness.

Rehabilitation

Neuro-physiotherapy and occupational therapy

NICE says you should be assessed by rehabilitation specialists to set your own goals for mobility and daily life. Courses are often in blocks of a few weeks.

Self-help

Managing energy

  • Keep a fatigue diary to spot your patterns
  • Plan, prioritise and pace your tasks
  • Take real rest breaks, not just lighter jobs
  • Keep cool. Heat often makes symptoms worse
  • Try an online fatigue course, such as FACETS

Staying well

  • Exercise regularly, at a level that suits you
  • Stretch daily to ease stiffness and spasms
  • Don't smoke. Smoking can make MS progress faster
  • Eat well and treat bladder infections and constipation quickly
  • Talk to someone if you feel low. Mood changes are common with MS

Getting the best care

Tips for appointments

  • Make sure you have contact details for an MS specialist nurse. They are often the quickest way to get help.
  • Keep a diary of symptoms, relapses, pain, fatigue and how they affect your work and home life. Take it to appointments.
  • Ask which DMTs you are eligible for, how well each works, and what monitoring it needs.
  • Ask for a referral to physiotherapy, occupational therapy, a spasticity clinic or a pain clinic if symptoms aren't controlled.
  • Expect a full review at least once a year, as NICE recommends. Ask for one if it hasn't happened.
  • If you aren't happy with your care, you can ask your GP for a second opinion from another neurologist.

MS and work

Under the Equality Act 2010, MS counts as a disability from the day you are diagnosed. You don't have to show how much it affects you. In Northern Ireland, the Disability Discrimination Act gives similar protection.

Your employer must make reasonable adjustments once they know, or should know, about your MS. What is reasonable depends on the job and the employer, but adjustments might include:

  • Flexible hours or a later start
  • Extra rest breaks for fatigue
  • Working from home
  • A desk near the toilet and the exit
  • A cool workspace or a desk fan
  • Time off for appointments and treatment
  • A phased return after a relapse
  • Not counting MS absence towards sickness triggers

Equipment that can help

  • Ergonomic chair with good support
  • Sit-stand desk
  • Perching stool
  • Voice recognition software
  • Lightweight or adapted keyboard and mouse
  • Footrest
  • Cooling vest
  • Walking aids
  • Accessible parking space

Access to Work is a government grant that can pay for equipment, support workers and travel to work if you can't use public transport. You don't have to tell your employer about MS, but you need to for them to make adjustments. The MS Society funds free legal advice for people with MS in England and Wales.

Benefits

Depending on how MS affects you, you may be able to get Statutory Sick Pay, Personal Independence Payment (PIP) or Adult Disability Payment in Scotland, new-style Employment and Support Allowance or Universal Credit. PIP is not means-tested, and you can get it while working. Because MS symptoms vary, describe how you are on a bad day as well as a good one. Turn2us, Citizens Advice and the MS Society helpline can help you check.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

  • A course of private neuro-physiotherapy for stiffness, spasms or balance
  • An occupational therapy assessment for work or home
  • A private consultation with an MS or pain specialist
  • A TENS machine or other equipment recommended by your doctor or therapist
  • Workplace or home equipment, such as an ergonomic chair, a sit-stand desk or a cooling vest
  • Travel to specialist treatment

We fund treatment, equipment and support, not general living costs. We can't fund disease-modifying therapies, which are only available through your NHS MS team. Prices vary, so always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

MS Society

Information, helpline and local groups

MS Helpline 0808 800 8000, Monday to Friday, 9am to 5pm. Also web chat, local groups and an online fatigue course.

mssociety.org.uk

MS Trust

Information and MS nurse support

Helpline 0800 032 3839, Monday to Friday, 10am to 4pm. Clear guides on symptoms, DMTs and work.

mstrust.org.uk
Sources for this guide

Last reviewed: October 2026.