Dermatologists are leading the effort to find out exactly how the coronavirus affects the skin. What to do if i banged my toe hard and the nail has gone purple..? ANA test. what should i do? Treatment of Raynaud's disease depends on its severity and whether you have other health conditions. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Treatment of the Raynaud phenomenon: Initial management. COVID toes begin with a bright red coloration on the fingers or toes, which then gradually turns purple. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Raynauds-Phenomenon. Accessed Oct. 20, 2020. having a history of vascular problems. Peripheral pulses were palpable in both legs. [Epub ahead of print]. I wear gloves and warm socks to prevent but still happening. Apr 24. doi: 10.1016/j.jaad.2020.04.093. This is a picture of my fingers after I let my dog out in 2012. Optimieren Sie Ihren Workflow mit unserem erstklassigen Digitalen Asset Management System. Treatments aim to restore blood flow to the toes. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.stroke.org/en/about-stroke/stroke-risk-factors/understanding-risky-conditions/atherosclerosis-and-stroke, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767657/, https://vascular.org/patient-resources/vascular-tests/angiogram, https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-2/Blue-Toe-Syndrome-Title-Blue-Toe-Syndrome, https://www.health.harvard.edu/healthbeat/these-five-habits-can-save-your-heart-heres-how, https://dermnetnz.org/topics/blue-toe-syndrome/, https://www.ncbi.nlm.nih.gov/books/NBK279392/. 4,528 purple toes stock photos, vectors, and illustrations are available royalty-free. This is mostly tied to the presence of emboli. PROVIDED PHOTO Weeks after recovering from the coronavirus, Karin Shetler's toes and then her fingers staring turning purple, which doctors say is post-viral inflammation from COVID-19.. You may also want to check your skin. Pinnwnde sind ideal zum Speichern von Bildern und Videoclips. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. The presence of the pulses of the foot makes it even harder to make a correct diagnosis. Terms & Conditions apply, Contact Us About Us Blog Privacy Policy Advertising Policy Sitemap. Sometimes, small bits of plaque break off, known as embolisation, and then travel round the body in the blood stream. If this fails to bring relief or symptoms worsen, contact a board-certified dermatologist. Blue toe syndrome can be difficult to diagnosis. Verify here. Select from premium Purple Toes Syndrome of the highest quality. Blue toe syndrome is associated with small vessel occlusion and can occur without obvious preceding trauma or disorders that produce generalised cyanosis, such as hypoxaemia or methaemoglobinaemia [1]. I performed a few and they have helped tremendously with my foot pain. https://www.mayoclinic.org/tests-procedures/ana-test/about/pac-20385204. Purple Fingers and Toes A 34-year-old female patient presented with painful erythematous papules on both hands and feet. I didnt even feel cold and yet this was the state of my hands. Davis MD, Dy KM, Nelson S. Presentation and outcome of purpura fulminans associated with peripheral gangrene in 12 patients at Mayo Clinic. Raynaud's most commonly affects fingers and toes. This might occur when too much plaque sticks to the inside of arteries, or when a plaque fragment or a blood clot blocks a blood vessel in the foot. Other symptoms can include: pain. Patients receiving vasopressors may also develop purple toes; however this is a result of vasoconstriction and ischemia. This site complies with the HONcode standard for trustworthy health information: verify here. Skin of color can look swollen and purple, and brownish-purple spots may. Rash on COVID-19 patients thigh: This rash could also be mistaken for hives. Additionally, the change in the color of toes and the toenails may be a result of trauma. now pain(burning) in both knees started, front center length of knees when i bend them. If you have any concerns with your skin or its treatment, see a dermatologist for advice. To aid the diagnostic process, several tests and procedures may be done. [1] It is painful and I my hands/feet/nose are always cold. My hands after coming from a surf on a beautiful sunny day. Int J Dermatol 2007; 46: 2318. 2020 Apr 24. doi: 10.1016/j.jaad.2020.04.094. Causes include medication-induced vasoconstriction (eg, a beta-blocker or illicit drug such as cocaine) and/or, Pain in the affected blue toe or toes is usually of acute onset and occurs at rest. There is no single COVID-19 rash. A doctor should take a complete and thorough history to identify if there are any factors that can rule out the blue toe syndrome. I am looking into buying heating gloves and socks because the regular ones are not enough. Louise H. 13. Depending on your skin color, these color changes may be harder or easier to see. During an attack of Raynaud's, affected areas of the skin usually first turn pale. crystals or a lump of plaque getting stuck. Deep vein thrombosis is the formation of blood clots in a deep vein that can be fatal. If I dont cover up in cold weather or I dont eat when its time I get white fingers. Vascular surgery means any operation on the vascular system. The skin on one or more of your toes or fingers may swell up and look bright red, then gradually turn purple. privacy practices. A persons blood carries oxygen from the lungs to every part of their body. Here we will look at the common symptoms, causes, diagnosis and treatment options for blue toe syndrome. It will also explore the possible complications of blue toe syndrome and when to see a doctor. Bosworth T. Heterogeneity seen in COVID-19 skin manifestations. Medscape Dermatology. Dr. Paller says it can last 10 to 14 days. COVID toes: One or more toes may swell and turn pink, red, or a purplish color. What you need to know about Raynaud's disease, What to know about subclavian steal syndrome, Peripheral vascular disease: What to know, cleaning waste products from the blood and eliminating them in the urine, making sure the blood has the balance of nutrients that cells need these include sodium, potassium, and calcium, producing hormones that control blood pressure and red blood cells, blue or black skin appearance can vary with darker or lighter skin. Advertising revenue supports our not-for-profit mission. Good morning doctors. Let's look at the causes of purple toenails. Dermatologists care for people of all ages. You may have noticed that other parts of your body take on a bluish purple color when they become too cold, or if you wear tight clothing, which can cut off blood . Arch Intern Med 1992; 152: 2197202. Find out how a board-certified dermatologist helped Natalie see clear skin before her wedding. The affected body parts, usually fingers and toes, might turn white then blue. If you are a Mayo Clinic patient, this could Skin Discoloration- Purple Discoloration Of The Skin- Observed in ischemic leg. Vergrern Sie die Reichweite Ihrer Marke authentisch und teilen Sie Markeninhalte mit Kreativen im Internet. Fungal infection Nail fungus, or simply put, a fungal infection is the most common cause of purple toenails. Any organ or tissue can be affected, although the skin and skeletal muscles of the lower extremities are almost always involved [8]. Moreover, due to the pooling of blood at the area of the out-pouching, there may be reduced blood flow into or out of the foot. Some people develop painful raised bumps or areas of rough skin. 1-4 More proximally, however, the solar aspect contained irregular dark-purple dots reminiscent of individual thrombosed venules, and in addition showed discontinuous purple zones more proximally in the part of the ray that lay within the body of the foot . Hands too. JC L. 11. ! Huh? More information is needed to know for sure. It also includes use of anticoagulant drugs, for example aspirin-which also serves as a pain medication. Purple toe syndrome is a rarely reported adverse effect of warfarin.In all described cases, the syndrome occurred relatively quickly after initiation of warfarin with little recommendation for treatment in patients needing continued anticoagulation. It can arise abruptly and develop into a painful condition quickly. COVID-19 is different. JAK inhibitors are helping patients with alopecia areata, eczema/atopic dermatitis, psoriasis, and vitiligo. health information, we will treat all of that information as protected health The non-discoloured areas of the foot and, The affected toes are cold compared to unaffected parts of the foot, which are warmer and appear well-, Cardiac murmur (infective endocarditis and atrial myxoma), Hollenhorst plaques (cholesterol emboli) noted on retinal examination, A peripheral angiogram and a scan of the limb arteries (to locate vessel narrowing, occlusion, and/or determine the source of emboli). If doctors do not restore blood flow to the foot, the tissues can die permanently. 16. the er dr said it was a bruise. The fragile skin of EDS means scars may not heal quickly or properly. It can cause more serious symptoms than the primary kind. 2020 Apr 10;S0190-9622(20)30556-9. Measles-like bumps on the foot of a patient with COVID-19: Dermatologists have seen bumps that look like measles on the chest, back, and other areas of patients who have COVID-19. I would take a history to see if the toe was bruised or not and if you are taking Warfarin. I dont what? Rarely, very bad untreated instances might require removing the affected part of the body. pictures of purple toe syndrome pictures of purple toe syndrome July 4th, 2022 by | Filed under ice dance olympics 2022 winners.ice dance olympics 2022 winners. She had a 25 pack-year history of cigarette smoking and denied any drug intake. There may also be scattered areas of petechiae or cyanosis of the soles of the feet. In the absence of pressure and/or shear, these injuries should not be diagnosed as pressure . | The affected areas may feel cold and numb until blood flow improves, usually after warming up. Pediatric dermatologist explains 'COVID toes. Dermatology Times, May 20, 2020. other information we have about you. Blue toe syndrome: ischaemia. Ankle-Brachial Index was 1.16 and 1.18 on the right and the left, respectively. Blue toe syndrome (blue toe syndrome is a lack of blood flow to the toes causing a blue discoloration) is found to be associated with 317 drugs and 160 conditions by eHealthMe. Raynauds phenomenon is a condition that affects circulation, causing decreased blood flow to the extremities (most commonly the fingers and toes). Raynaud syndrome (adult). 2023 Getty Images. This is an important point as warfarin . To provide you with the most relevant and helpful information, and understand which It helps to avoid activities that may lead to further injury such as heavy lifting, running, or jumping, to wear supportive footwear, and to take pain medications as needed. Swelling. Woman hand touching little toe with purple bruise after home. I also have POTS [postural orthostatic tachycardia syndrome] and IST [inappropriate sinus tachycardia]. Elsevier; 2020. https://www.clinicalkey.com. Not getting enough blood damages cells and the tissues they make up. Blue toe syndrome is a clinical diagnosis based on patient history and findings on examination. I am concerned with things on my or my children's bodies that are not right. The syndrome usually develops 3-8 weeks after the start of warfarin therapy. "Blue toe" syndrome. Hirschmann JV, Raugi GJ. The treatments kind of contradict each other and its making this winter particularly difficult. is this ok? A full blood count including a white cell differential, erythrocyte sedimentation rate, and C-reactive protein may indicate elevated inflammatory markers. All registration fields are required. Neuropathy Peripheral neuropathy can be the cause for color changes in the feet and toes. COVID toes: A deep red appearance may be due to vascular inflammation. Keep in mind that you can have a rash thats due to a condition other than COVID-19. All of these conditions cause reduced blood supply to the feet and can lead to discoloration, numbness, and pain. If blue toe syndrome is not sounding quite like your problem, visit the toe pain diagnosis section for help working out what may be causing your pain. The plantar aspect of this toe shows purple nonuniform darkening that mimicked either a simple traumatic hematoma or the blue toe syndrome. All rights reserved. Use these professionally produced online infographics, posters, and videos to help others find and prevent skin cancer. For example, renal failure can have long-term effects. Presence of abnormalities in the blood circulation. An aneurysm refers to the presence of an out pouching along the vessel wall. For most people, Raynaud's disease isn't disabling, but it can affect your quality of life. Reply to: COVID-19 can present with a rash and be mistaken for dengue: Petechial rash in a patient with COVID-19 infection. J Am Acad Dermatol. We avoid using tertiary references. But now, the results of a new study, published Oct. 5 in the British Journal of Dermatology, hint at why the reddish-purple papules pop up on the toes and sometimes the fingers. Luckily my service dog generates a lot of heat so I can ask her to lay on my feet or bury my hands under her chin to warm up when we are out and about and I always bring a jacket even when its warm out at home I am constantly burying my feet under my animals or getting extra blankets to keep warm. Bay H. 9. Cold temperatures are the most likely cause of an attack. Haematological treatment may be required when blue toe syndrome is due to hyperviscosity [14]. Urticarial exanthem as early diagnostic clue for COVID-19 infection, JAAD Case Rep. 2020 Apr 29. doi: 10.1016/j.jdcr.2020.04.026. It can smooth out deep wrinkles and lines, but the results arent permanent. Examples are putting hands in cold water, taking something from a freezer or being in cold air. Blood vessels narrow and can almost shut down, causing. Is Blue Toe Syndrome Dangerous? The most frequent side effect is bleeding, which is most effectively avoided by making sure you keep your prothrombin time (nowadays called the INR, short for International Normalized Ratio) in the range your doctor has set. Privacy It sucks to live with but we need to keep ourselves warm. Heating blanket is my best friend. Heres how. The principles of treatment revolve around addressing the cause of the blue toe syndrome. Purple toes syndrome is an extremely uncommon, nonhemorrhagic, cutaneous complication associated with warfarin therapy. The advantages of ultrasound are clear images, low cost, and low risk. Aside from impeding your. [Epub ahead of print]. The toes do not appear to have hemorrhagic lesions. When there is too much cholesterol in the blood, it can mix with other substances to form plaque. Chilblains causes the skin on your toes, other parts of your feet, fingers, or other affected areas to burn and itch. An angiogram is a medical procedure. best time to see dolphins in fort myers pictures of purple toe syndrome Organisieren, kontrollieren, verteilen und messen Sie alle Ihre digitalen Inhalte. 2020 May 4. doi: 10.1016/j.jaad.2020.04.161. information highlighted below and resubmit the form. 3. The syndrome usually develops 3-8 weeks after the start of warfarin therapy. What you may see with COVID toes: The condition may develop on your toes, fingers, or both. Browse 1,738 purple toes stock photos and images available, or start a new search to explore more stock photos and images. Oops! While COVID toes can appear at any age, children, teenagers, and young adults seem most likely to develop this condition. Depending on your skin color, these color changes may be harder or easier to see. Other conditions that can present in a similar way to blue toe syndrome include Raynaud's disease, blood clotting disorders, arterial insufficiency, Buerger's disease, and peripheral neuropathy. This may result in blockage of the vessels affected, preventing flow of blood through the arteries, or outflow of blood through the veins. Raynaud's phenomenon An update on diagnosis, classification and management. Accessed Sept. 29, 2022. A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Early treatment involves debridement (surgical removal of the dead tissue) and antibiotics to treat infection. Blue toe syndrome is caused by a blockage of the small blood vessels in the foot that reduces the flow of blood and oxygen to the tissues. With broken toes they are usually strapped to the next toe. Marzano AV, Genovese G, et al. The blockage or narrowing of arteries by the small clots that lead to blue toe syndrome can result from a number of different conditions. A vascular surgeon takes a healthy blood vessel from another part of the body and creates a bypass around the blockage. This is known as peripheral cyanosis. DOI: 10.1001/archsurg.1976.01360290097015. Doctors around the world have noticed that some patients who test positive for the coronavirus develop discolored and swollen toes. Physical exam revealed purple toes with severe tenderness to touch and a dry small ulcer on the left forth toe (Figure 1). Occlusive vasculopathy, often known as blue toe syndrome, is a kind of acute digital ischemia in which one or more toes turn blue or violet in color. If you have any symptoms of COVID-19, contact your doctor. 8, 9 The big toes are affected most often. Rich, US, This site complies with the HONcode standard for trustworthy Numb, prickly feeling or stinging pain upon warming or stress relief. Chilblains develops when youre exposed to cold temperatures. 1. Henry D, Ackerman M, et al. health information. Some people see their skin swell and turn red or dark blue. Sometimes, pieces of plaque can break away from the artery walls and travel around the body in the bloodstream until they get stuck. It is actually rare to be allergic or to have a reaction to a leech bite. Abnormal venous drainage associated with extensive venous thrombosis results in phlegmasia cerulea dolens (a painful form of blue toe syndrome associated with leg oedema). 2-4, 5-8: Images used with permission of Journal of the American Academy of Dermatology and JAAD Case Reports. This is usually a common cause of relapse in people who had been successfully treated for blue toe nails. However, cholesterol fragments blocking blood vessels to other organs can lead to multi-organ disorder [1]. There are two main types of the condition. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. difficulty moving the affected area. Alternative treatments for ehlers danlos syndrome, Alternative treatments for parsonage turner syndrome, Unani treatments for polycystic ovarian syndrome. "Cindy, US, "3 days ago I thought I was going to need foot surgery. Gangrene is a serious condition where a lack of blood supply causes the tissue to die. To help, ask your doctor to submit information to the American Academy of Dermatologys COVID-19 registry. For those with secondary Raynauds, the most common primary conditions include lupus, scleroderma, rheumatoid arthritis and Sjgrens syndrome. If you want to diminish a noticeable scar, know these 10 things before having laser treatment. That's later than symptoms appear for primary Raynaud's. DOI: 10.111/j.1365-4632.2007.03160.x. The mechanism is actually not very clear. Because air conditioning can cause attacks, set your air conditioner to a warmer temperature. This article explains what blue toe syndrome is, what it feels like, its causes, and how doctors treat it. Itchy rash: While in the hospital for COVID-19, this patient developed an itchy rash on both sides of his body. Blue toe syndrome or gray toe syndrome or purple toe syndrome refers to discoloration of the toenails, causing them to take on a blue hue or a colour that closely resembles blue. Cutaneous manifestations in COVID-19: Lessons learned from current evidence. J Am Acad Dermatol. A purple toe is not right. Achenbach syndrome of the fingers Who gets Achenbach syndrome? The causes include: An embolus refers to an abnormal or foreign material that flows through the blood vessels and may lodge in one of the vessels. There, youll also find thoughts and questions by our community. Achenbach syndrome has been predominantly reported in middle-aged females, with a median age of onset of 48-50 years (range 22-76). . These hands make me feel so useless. 1540) entitled "purple toe syndrome" 1. Cold fingers or toes. When you're cold, anxious or stressed, your fingers and toes may change colour. Some people find it helpful to wear mittens and socks to bed during winter. Heres what you need to know. Skin ulcerations and gangrene (pictured below) of the digits (fingers and toes) are common in Buerger's disease . This holds the vessel open so the blood can get through. 13th ed. Chilblains are a common cutaneous finding during the COVID-19 pandemic: a retrospective nationwide study from France. J Am Acad Dermatol. How long COVID toes last: While COVID toes go away without treatment, its still too soon to know how long most people have the condition. Secondary Raynaud's. Blue or purple toe syndrome develops when there is a blockage in the small blood vessels of the foot. Abstract Purple toes syndrome is an extremely uncommon, nonhemorrhagic, cutaneous complication associated with warfarin therapy. Focus on COVID toes. JAMA Dermatol. [Epub ahead of print]. For months, red and purple bumps have been showing up on the fingers and toes of Covid-19 patients - dubbed 'Covid fingers and toes'. itchy, dark purple spot at bite. include protected health information. When this occurs in the foot, it can result in blue toe syndrome. Arch Intern Med 1994; 154: 102931. It seems to be more common in people who live in colder climates. Learn more about it here. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). See blue toe syndrome stock video clips Image type Orientation Color People Artists More Sort by Popular Diseases, Viruses, and Disorders Families Children Healthcare and Medical Geography and Landscapes baby White hooman paws just before the shower water got hot. Purple or blue feet may be a sign of an underlying health condition. The most common reason for purple toe syndrome is a blockage of blood vessels in the foot. BTS is characterized by the development of blue or purple discolored toes, usually occurring without any report of trauma, cyanosis, or severe hypothermia. your toes turn blue suddenly for no obvious reason and are extremely painful, there is a good chance the blood flow to the foot may be affected which would require immediate medical attention. What is Blue Toe Syndrome? Evaluation of chilblains as a manifestation of the COVID-19 Pandemic. The kidneys have several roles within a persons body: When the kidneys cannot function properly, it is known as renal failure. Browse our free newsletters Everyone's at risk for skin cancer. As well as blue or purple toes, someone with blue toe syndrome might have: Blue toe syndrome occurs when a blockage in the small blood vessels in the foot stops the tissues from getting enough blood. At first, the toes look swollen and take on a reddish tint; sometimes a part of the toe is swollen, and individual lesions or bumps can be seen. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The blood count and peripheral blood film can help diagnose bone marrow or autoimmune diseases. All rights reserved. Dtsch Arztebl Int 2014; 111: 20511. Areas of skin that turn white then blue. Discolouration may affect one foot or both, depending on the underlying pathophysiology. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. The terms peripheral emboli, lower extremity atheromatous emboli syndrome, blue toe syndrome, purple toe syndrome, and trash foot refer to special cases of CE to the lower extremities in which cutaneous manifestations are usually present, the latter three occurring in association with . Without treatment, the lack of oxygen can cause the skin and underlying tissue to eventually die. Hier knnen Sie Inhalte sammeln, auswhlen und Anmerkungen zu Ihren Dateien hinterlegen. obesity. [Epub ahead of print]. 2020 Jun 25. doi:10.1001/jamadermatol.2020.2368. Heart failure: Could a low sodium diet sometimes do more harm than good? To take food out of the refrigerator or freezer, wear gloves, mittens or oven mitts. The toes start to turn a bluey purple colour (known as cyanosis) due to the lack of oxygen, hence the name blue toe syndrome. The nail is attached to the nail bed. Athlete's foot is a fungus that causes itching, redness, and cracking. Theyre fine, thats just how they look. an interaction Ive had 856 times at least. Kaari P. 14. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. The histopathological findings for cholesterol emboli show intravascular cholesterol crystals, which may be associated with macrophages, giant cells, and eosinophils [13]. The majority of lesions are bilateral and the skin blanches with pressure. The blue-ish discoloration is often a result of tissue death, following impaired circulation. When this plaque sticks to the walls of the arteries, it makes them narrower, causing atherosclerosis. Heres what our community shared with us: 1. COVID toes can range from affecting one toe to all of them. Petechiae or cyanosis of the soles of the feet may be present in isolated areas. Subclavian steal syndrome is a condition that affects the arteries that supply the blood to the head, neck, and arms. Sokumbi O (expert opinion). The same can happen with blood clots. If you experience this condition as well, let us know how it affects you in the comments below. If this happens, amputation may be necessary so early treatment is essential. Another common cause is Raynauds Disease, a condition where the blood vessels spasm, limiting flow to the fingers and toes. Rivera-Oyola R, Koschitzky M, et al. Doctors place a needle into an artery at the groin, then thread thin tubes called catheters through the arterial system. 8. Wear earmuffs and a face mask if the tip of your nose and your earlobes get too cold. [Epub ahead of print]. 2020 Apr 16. doi: 10.1016/j.jaad.2020.04.045. my send toe, next to the big toe is purple. "Jennifer, UK, "I have suffered these symptoms for over a year, seen two doctors and a physio. Kylee P. Advertisement. I cant afford to risk ulcers though. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. It most often presents in an older man who has undergone a vascular procedure. The clinical features of blue toe syndrome can range from an isolated blue and painful toe to a diffuse multi-organ system disease that can mimic other systemic illnesses. References This can be difficult to treat. Cutaneous manifestations in COVID-19: A new contribution. J Eur Acad Dermatol Venereol 2020 Apr 15. doi: 10.1111/jdv.16474. Author: Catherine Tian, Medical Student, Department of Dermatology, University of Auckland, Auckland, New Zealand. A rash can also be a sign of another disease. Circulation 2007; 116: 298304. Germs can enter through the cracks in your skin and cause an infection. Classically this condition occurs bilaterally and the discolouration blanches with pressure2. ischaemia. When one or more of a persons toes starts to look blue or purple, doctors call it blue toe syndrome. But you have to know the limitation of the test. Bundle up outdoors. Achenbach syndrome is a paroxysmal recurring painful bruising of the finger (s) or palm, not associated with serious underlying conditions. Treatment here is usually with medication, avoiding the cold by wearing gloves and relaxation techniques. J Am Acad Dermatol. No purpura or livedo was found. Histology of cholesterol emboli causing blue toe syndrome, 162746008, 236489002, 54687002, 312378004, 66877004, 402676001, 373408007, 432083006, anticoagulation (especially antiplatelet drugs). Though Raynauds does not cause permanent damage, the symptoms can be quite painful and uncomfortable.