Drug therapy for pain in amyotrophic lateral sclerosis or motor neuron disease

Brettschneider, Johannes; Kurent, Jerome E.; Ludolph, Albert C.

doi:10.1002/14651858.cd005226.pub3

Cited by 40 publications

(30 citation statements)

References 51 publications

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“…A careful history combined with detailed neurologic and musculoskeletal exams can help identify the pain generator(s) and direct treatment. It should be noted, however, that recommendations for treatment of pain and spasticity in ALS are based mostly on expert opinion, as very few studies have been conducted to analyze the efficacy of specific medications or other interventions …”

Section: Case Study 2: Middle‐stage Alsmentioning

confidence: 99%

Rehabilitation in amyotrophic lateral sclerosis: Why it matters

Majmudar

Paganoni

2014

Muscle and Nerve

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Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that results in a constellation of problematic symptoms and a high patient and caregiver burden. Multidisciplinary care includes rehabilitation interventions that have the goal of assisting people to teach their fullest potential despite the presence of a disabling disease. Given the progressive nature of ALS, the clinician must be aware of the expected disease trajectory and apply appropriate interventions at each stage. This review will present rehabilitation strategies that can be utilized to maximize patient independence, function, safety, and quality of life, and to minimize disease-related symptoms. The role of bracing, exercise, assistive devices, and adaptive equipment will be discussed. At each disease stage, an experienced rehabilitation team is well positioned to make a significant impact on the life of ALS patients. Keywordsbraces; exercise; multidisciplinary care; physical therapy; rehabilitation "Can you cure ALS?" "I am afraid I can't." "What else can you offer then?" "Rehabilitation for ALS? I thought there is nothing you can do for this disease."It is this type of conversation with patients and their families that prompted this review on the importance of rehabilitation in amyotrophic lateral sclerosis (ALS). ALS is a fatal neurodegenerative disease that produces a constellation of symptoms, including muscle weakness, wasting, fatigue, spasticity, cramps, muscle twitches, dysphagia, dysarthria, respiratory failure, and, in some patients, cognitive and mood changes. The disease typically leads to death within 3-5 years after diagnosis, 1,2 with ventilatory muscle failure as the most common cause of death. 3 The only U.S. HHS Public AccessAuthor manuscript Muscle Nerve. Author manuscript; available in PMC 2015 July 01. Published in final edited form as:Muscle Nerve. 2014 July ; 50(1): 4-13. doi:10.1002/mus.24202. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript drug for ALS, riluzole, only confers a modest survival benefit. 4,5 Thus, most of the care of people with ALS (PALS) is supportive and centered around symptom management, making ALS an incurable, yet treatable disease. REHABILITATION AS MULTIDISCIPLINARY CARERehabilitation is the process of assisting a person to maximize function and quality of life.Although there are no curative treatments for ALS, rehabilitation can assist people to continue to function independently and safely, manage their symptoms, and, most importantly, live a fulfilling life despite having a disease that is known to shorten lifespan. Therefore, rehabilitation matters to PALS, because it enables them to reach their fullest potential despite the presence of a disabling disease. Further, it is likely that rehabilitation will become even more essential when caring for PALS in the near future, as more treatments will hopefully be developed to delay disease progression and prolong lifespan.The ALS practice parameter of the American Academy of Neurology (AAN) currently rec...

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Section: Case Study 2: Middle‐stage Alsmentioning

confidence: 99%

Rehabilitation in amyotrophic lateral sclerosis: Why it matters

Majmudar

Paganoni

2014

Muscle and Nerve

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“…It is a neglected aspect of this disease,38 as illustrated by the dearth of specific clinical trials 39. The two populations reported in the present study are very different (different age, normal muscles in the healthy subjects versus atrophied muscles in the patients, etc) and were subjected to opposite interventions.…”

Section: Discussionmentioning

confidence: 82%

Relieving dyspnoea by non-invasive ventilation decreases pain thresholds in amyotrophic lateral sclerosis

Dangers

Laviolette

Georges

et al. 2016

Thorax

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Relieving dyspnoea by NIV in patients with ALS having respiratory failure is associated with decreased pressure pain thresholds. Clinical implications have yet to be determined, but this observation suggests that patients with ALS could become more susceptible to pain after the institution of NIV, hence the need for reinforced attention towards potentially painful diagnostic and therapeutic interventions.

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“…Pharmacologic treatment of pain may also be needed using one or more of several agents. The choice of the specific compound is based on clinician experience as there has been no trials of drug therapy for pain in ALS (Brettschneider, Kurent, & Ludolph, 2013). Options include non-steroidal anti-inflammatory medications (NSAIDs), acetaminophen and medications for neuropathic pain.…”

Section: Symptom Management As Als Progresses: Medications and Assistmentioning

confidence: 99%

Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis

Paganoni

Karam

Joyce

et al. 2015

NRE

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Background Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) is a neurodegenerative disease that results in progressive muscle weakness and wasting. There is no known cure and the disease is uniformly fatal. Purpose This review discusses current concepts in ALS care, from breaking the diagnosis to end-of-life care. People with ALS have several multidisciplinary needs due to a complex and dynamic disease process. They benefit from rehabilitation interventions that are individualized and have the goal of optimizing independence, function, and safety. These strategies also help minimize symptomatic burden and maximize quality of life. Conclusion Patient-centered, multidisciplinary care has a significant impact on the life of people with ALS and is the current standard of care for this patient population.

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Drug therapy for pain in amyotrophic lateral sclerosis or motor neuron disease

Cited by 40 publications

References 51 publications

Rehabilitation in amyotrophic lateral sclerosis: Why it matters

Rehabilitation in amyotrophic lateral sclerosis: Why it matters

Relieving dyspnoea by non-invasive ventilation decreases pain thresholds in amyotrophic lateral sclerosis

Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis

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