Burning Sensation and Multiple Sclerosis: Symptoms, Causes, Diagnosis, and Relief

• TL;DR: A burning sensation can be a neuropathic pain symptom in MS. It often comes from damaged nerve pathways, not skin injury.
• New, clearly different, or worsening burning that lasts over 24 hours-especially with other neurologic changes-may signal a relapse and deserves prompt medical review.
• Common triggers include heat, infection, stress, and fatigue. Cooling, gentle movement, sleep, and evidence-based pain meds can help.
• First-line medicines for neuropathic pain (per major guidelines) include gabapentin, pregabalin, duloxetine, and amitriptyline. Opioids are a poor fit.
• Rule out look-alikes like shingles, pinched nerve, or small‑fiber neuropathy. Track patterns and seek care if red flags appear.

A sudden burn under your skin with no mark to show for it can be scary. If you live with MS-or you’re worried you might-knowing when that burning is part of the disease and when it’s something else can save you stress and time. Here’s a clear, practical guide to what’s going on, what to do next, and how to feel more in control.

What that burning sensation means in MS (and how to tell it from look‑alikes)

MS can cause pain, and burning is one of the classic types. This is neuropathic pain-pain that starts in the nerves themselves because myelin or the nerve fibers are damaged. People often describe it as hot, fiery, stinging, or like a sunburn under clothes. It might stay in one area (a patch on the thigh) or follow a band around the trunk. Sometimes it flickers in and out, other times it lingers for hours.

Why it happens: in MS, inflammation in the brain or spinal cord disrupts signals, so normal input (clothes, shower, temperature change) can feel painfully “amplified.” The burning can show up in areas controlled by the affected pathways. If the lesion is in the cervical spinal cord, you might feel symptoms in the arms or trunk; thoracic lesions often map to the chest or abdomen; lumbar lesions to the legs and feet.

How common is pain in MS? Pain affects a large share of people with MS across the disease course. Systematic reviews published in Multiple Sclerosis Journal report that over half of people with MS experience pain, and neuropathic pain is a frequent subtype. The National MS Society also notes burning and other dysesthesias as core sensory symptoms.

Burning vs. other MS sensations:

• Dysesthesia: burning, scalding, squeezing, or crawling feelings with no skin cause.
• Allodynia: pain from light touch (clothes, sheets) that shouldn’t hurt.
• Lhermitte’s sign: an electric shock down the spine into limbs when you bend your neck-brief and zappy, not a steady burn.

Relapse or not? A relapse means new neurological symptoms or a clear worsening of old ones lasting at least 24 hours, not explained by infection or heat. A burning sensation can be part of a relapse when it’s new or distinctly worse, sticks around, and shows up with objective changes (e.g., new numbness spreading, weakness, balance trouble). The American Academy of Neurology and National MS Society align on these principles.

Heat and pseudo‑relapse: If your burning flares with hot weather, a fever, a long shower, or hard exercise and then settles as you cool down, that points to Uhthoff’s phenomenon (a temporary conduction block). Uncomfortable? Yes. A relapse? No. Cooling strategies help.

When it’s probably not MS:

• Shingles: burning pain followed by a one‑sided blistering rash in a nerve strip (dermatome). The pain often starts days before the rash.
• Pinched nerve (radiculopathy): burning or shooting pain travels from the neck or back down an arm or leg, often with certain movements or positions.
• Small‑fiber neuropathy: burning in the feet/hands, worse at night; often symmetric; can be linked to diabetes, thyroid issues, B‑12 deficiency, or chemo.
• Transverse myelitis: band‑like trunk burning/numbness with tightness, weakness, bladder changes-this can overlap with MS or be separate. Needs urgent care.

Quick decision helper:

1. Is there fever, new rash, or signs of infection? If yes, treat infection first-MS symptoms often settle after.
2. Is the burning brand‑new or clearly worse for >24 hours with other neurologic changes? If yes, contact your MS team within 24-48 hours.
3. Does heat reliably trigger it, and does cooling settle it? If yes, it’s likely a temporary conduction issue; optimize cooling and rest.
4. Is it following a nerve path with movement‑dependent flares? Think pinched nerve; see your GP/physio.
5. Is it severe, with weakness, bladder retention, or rapid spread? Seek urgent care.

One more nuance: pain intensity doesn’t always match MRI activity. You can have severe burning with a stable scan, because pain circuits can “sensitize.” That’s real pain. It still deserves treatment.

What to do now: step‑by‑step relief, workup, and treatment options

Here’s a simple plan you can use today and discuss with your clinician. It blends self‑care, sensible testing, and guideline‑backed treatments. In New Zealand, your GP is a good first stop; they can loop in neurology via Te Whatu Ora and prescribe most first‑line options.

Step‑by‑step:

1. Log the pattern today. Where is the burn? When did it start? What triggers it (heat, stress, position, clothing)? Any weakness, numbness spread, vision changes, bladder issues? Rate pain (0-10) morning/afternoon/night for three days.
2. Screen for triggers. Check for fever, urinary symptoms (could be a UTI), or recent overexertion. Cool down: tepid shower, fans, breathable layers, cool drink. In Auckland’s humidity, a cooling towel or vest helps.
3. Try fast, low‑risk relief. Gentle mobility (ankle pumps, neck range without forcing), paced rest, a brief cool pack wrapped in cloth. Consider topical lidocaine patches (chemist) for small areas. Avoid direct ice on skin.
4. Call your GP or MS nurse if it’s new/worse >24 hours, or you have other neurological changes. Ask: Do I need infection screening? Is this likely neuropathic pain? Should we adjust meds? Do I need a relapse assessment?
5. If relapse is likely, your team may consider high‑dose corticosteroids. These shorten relapse duration but don’t fix long‑term disability. They’re used when there’s functional impact (e.g., new weakness, vision loss). Burning alone rarely needs steroids unless paired with other deficits.

Medications that help neuropathic burning (evidence‑based):

• Gabapentin or pregabalin: often first‑line in MS neuropathic pain. Start low, go slow to reduce dizziness and fogginess. Expect benefit over 1-2 weeks as doses build.
• Duloxetine (an SNRI): helpful when low mood and poor sleep ride along with pain. Can cause nausea early on; usually eases in a week.
• Amitriptyline (low dose at night): good for sleep and pain, but can cause dry mouth and morning grogginess. Useful if nighttime burning dominates.
• Topical agents (lidocaine patches; capsaicin cream/patches): handy for small, well‑defined zones. Capsaicin can sting before it helps; wash hands carefully.

These choices line up with the NICE neuropathic pain guideline and pain society recommendations. The American Academy of Neurology also supports these as reasonable first‑line options for neuropathic pain, including in MS. Opioids are generally a poor fit for neuropathic pain and can make fatigue and constipation worse; most guidelines advise against them outside short, specific scenarios.

Non‑drug supports with real‑world traction:

• Cooling strategies: lightweight layers, pre‑cool before exercise, chilled water bottle, cooling garments during summer or workouts. In hot NZ summers, plan activity in the morning or evening.
• Physio and gentle movement: keeps joints moving, reduces guarding that can amplify pain. Aim for short, frequent bouts.
• Desensitisation: graded exposure to touch/texture using soft to firmer fabrics for a few minutes daily can retrain sensitivity over weeks.
• Mind‑body tools: CBT, mindfulness‑based stress reduction, and paced breathing reduce the brain’s “volume knob” on pain. This doesn’t mean pain is “in your head”; it’s about calming a sensitised system.
• Sleep protection: set a wind‑down routine; avoid late caffeine; if burning peaks at night, ask about a night‑time dose of your pain med.
• TENS units: some people get relief for surface burning with a low‑cost device. Trial and keep if it helps.

When you should seek urgent care:

• New weakness, face droop, trouble speaking, or sudden vision loss.
• New bladder retention or severe constipation with back pain.
• Fever with worsening neurologic symptoms (possible infection).
• Severe band‑like tightness across the chest/abdomen with sensory changes or weakness (possible myelitis).
• A blistering rash with burning pain (possible shingles-early antivirals shorten the course).

What tests might be useful?

• Clinical exam: pinprick, temperature, vibration, reflexes, strength, and gait tell a lot.
• Urine test if relapse is suspected, to rule out UTI as a pseudo‑relapse driver.
• MRI if the pattern suggests new CNS activity and results would change management.
• Bloods if a non‑MS neuropathy is possible: B‑12, HbA1c/glucose, thyroid, folate, and others as guided by history.

What about cannabis‑based medicines? Evidence is mixed. Oral cannabinoids show small benefit for spasticity; the signal for neuropathic pain relief is modest and variable. Access and prescribing rules differ in NZ under the Medicinal Cannabis Scheme. If you’re considering it, discuss interactions, sedation, driving, and cost with your doctor.

Vitamin D, diet, and supplements: vitamin D matters for MS risk and may relate to disease activity, but it’s not a direct fix for burning pain. An anti‑inflammatory eating pattern (plenty of plants, omega‑3s, low ultra‑processed foods) supports overall health and mood, which indirectly helps pain. Check B‑12 if you’re plant‑based without supplementation.

Pro tips from clinic floors:

• Time your meds: take sedating options at night; energising ones in the morning.
• Change one thing at a time: add or adjust a single drug or strategy so you know what helps.
• Set a 2-4 week review: neuropathic pain meds need time and dose titration to show their best.

Living with burning pain in MS: practical checklists, examples, and your next move

Here’s how to turn the theory into your daily routine without it taking over your life.

Daily checklist (5 minutes):

• Morning: rate burning (0-10), note sleep quality, body temp/heat exposure.
• Midday: brief cool break; stretch or short walk; hydration check.
• Evening: trigger review (heat, stress, infection signs), gentle wind‑down, medication taken?
• Weekly: reassess what actually helped; adjust one variable; schedule follow‑up if needed.

Relapse vs. flare quick test:

• Does it last >24 hours without obvious trigger (heat/infection)? Yes → think relapse.
• Any new objective changes (weakness, balance, vision, bladder)? Yes → call your MS team.
• Back to baseline after cooling, rest, or antibiotic for UTI? Yes → likely flare/pseudo‑relapse.

Real‑life examples:

• Hot‑weather flares: A 34‑year‑old with MS gets a chest “sunburn” feeling on summer afternoons. Cooling vest + earlier gym sessions dropped pain from 6/10 to 2/10 most days.
• Night‑time burning: A 46‑year‑old wakes with burning calves at 2 a.m. Low‑dose amitriptyline at night plus calf stretches and a bedside fan reduces wake‑ups to once a week.
• New burning with weakness: A 29‑year‑old notices burning along the right torso and new clumsiness in the right leg for two days. GP rules out UTI; neurology confirms a relapse and treats with steroids, then adjusts disease‑modifying therapy.

Common pitfalls to avoid:

• Chasing every spike with new meds. Look for patterns and trends first.
• Overheating your way into a flare: hot yoga, saunas, very hot baths-experiment carefully and cool down after.
• Ignoring infections: untreated UTIs often make MS symptoms scream; treating them quiets the noise.
• Staying still. Gentle movement is better than bracing all day.

Mini‑FAQ

Can burning be the first sign of MS? Yes, sensory symptoms can be early. But many other issues cause burning too. If burning is new and unexplained-especially with visual changes, limb numbness, or imbalance-see your doctor. Diagnosis relies on history, exam, and MRI, not one symptom.

Does burning mean I’m getting worse? Not necessarily. Temporary flares from heat or infection are common. Worrisome signs are new, persistent changes with function loss. Track duration and context.

Will MRI always show the cause? No. You can have burning from old pathways that are now sensitised, or from lesions too small or subtle to clearly see. Your clinical picture matters most.

Are steroids good for burning pain? Steroids help shorten relapses that affect function. They don’t directly treat chronic neuropathic pain and can cause side effects. Use them when the benefits outweigh risks.

Which specialist should I see in NZ? Start with your GP. For MS‑specific care, neurologists and MS nurses coordinate through Te Whatu Ora services. A pain clinic or rehab physician can help if pain persists.

Can exercise make burning worse? Overheating can flare symptoms. The trick is short, cooler sessions with rest and hydration. Aqua therapy in a cooler pool works well for many.

What about alcohol? Alcohol can dull pain short‑term but worsens sleep and can interact with meds. If you drink, keep it light and observe next‑day pain levels.

Next steps, tailored:

• If you’re newly diagnosed: set up a simple symptom log and a 6-8 week review with your GP/neurologist to fine‑tune meds and cooling strategies.
• If you’ve had MS for years and this is new: rule out infection, check meds that increase heat sensitivity (some antidepressants, anticholinergics), and consider an MRI if function changed.
• If you don’t have an MS diagnosis but worry you might: book your GP, bring a timeline. Ask if your story warrants MRI or neurology referral. Keep an open mind-many causes are treatable and non‑MS.
• If you’re postpartum or perimenopausal: temperature swings and sleep loss can sharpen pain. Prioritise rest, cooling, and discuss med timing that’s safe for breastfeeding if relevant.
• If you’re rural: use telehealth. Your GP can start first‑line neuropathic meds while you wait for neurology input.

When to document and escalate:

• Write a one‑page summary: onset, triggers, associated symptoms, what helped, what didn’t, and any impact on walking, sleep, or work.
• If pain is ≥6/10 most days for two weeks despite self‑care, or you’ve had to stop usual activities, escalate to your GP for medication titration or a new plan.

Evidence and credibility notes: The National MS Society recognises burning dysesthesia as a common MS sensory symptom. The American Academy of Neurology advises that relapses are clinical events lasting at least 24 hours after excluding fever/infection. NICE’s neuropathic pain guideline supports first‑line use of gabapentin, pregabalin, duloxetine, or amitriptyline, with opioids generally discouraged. These principles remain current in 2025 and match everyday clinical practice.

Bottom line: if your burning sensation MS story fits heat sensitivity and settles with cooling, you can likely self‑manage and check in at your next appointment. If it’s new, different, and sticks around-especially with other neurologic changes-get assessed promptly. Relief usually comes from a smart combo of cooling, movement, sleep, and the right med at the right dose.