Pain in amyotrophic lateral sclerosis: a narrative review

Abstract

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative condition characterized by loss of motor neurons, resulting in motor weakness of the limbs and/or bulbar muscles. Pain is a prevalent but neglected symptom of ALS, and it has a significant negative impact on the quality of life of patients and their caregivers. This review outlines the epidemiology, clinical characteristics, underlying mechanisms, and management strategies of pain in ALS to improve clinical practice and patient outcomes related to pain. Pain is a prevalent symptom among patients with ALS, with a variable reported prevalence. It may occur at any stage of the disease and can involve any part of the body without a specific pattern. Primary pain includes neuropathic pain and pain from spasticity or cramps, while secondary pain is mainly nociceptive, occurring with the progression of muscle weakness and atrophy, prolonged immobility causing degenerative changes in joints and connective tissue, and long-term home mechanical ventilation. Prior to treatment, the exact patterns and causes of pain must first be identified, and the treatment should be tailored to each patient. Treatment options can be classified into pharmacological treatments, including nonsteroidal anti-inflammatory drugs, antiepileptic drugs, drugs for cramps or spasticity, and opioid; and nonpharmacological treatments, including positioning, splints, joint injections, and physical therapy. The development of standardized and specific assessment tools for pain-specific to ALS is required, as are further studies on treatments to reduce pain, diminish suffering, and improve the quality of life of patients with ALS.

Synucleinopathy in Amyotrophic Lateral Sclerosis: A Potential Avenue for Antisense Therapeutics?

“…With no current cure for the disease, ALS therapeutics have historically centred around attempting to slow the progression of the disease and providing symptomatic treatments to maintain and improve patient quality of life [ 167 ]. Pain management is integral to improving the quality of life, with a recent meta-analysis estimating a pooled prevalence of 60% of patients suffering from severe pain symptoms [ 168 ].…”

Health-related quality of life across disease stages in patients with amyotrophic lateral sclerosis: results from a real-world survey

“…Hence this appears to be a domain that is not only important to pALS, but, unlike mobility, self-care, and usual activities, should be treatable, offering the potential to improve patient outcomes in later stages of the disease. Effective pain treatment can improve pALS and cALS’ QoL, even in the absence of a disease cure [ 43 ].…”

Herbal medicine and acupuncture relieved progressive bulbar palsy for more than 3 years: A case report

“…[10] Although promising outcomes were obtained in preclinical studies, numerous compounds investigated failed in human clinical trials, [24,25] and there is no available treatment to stop or reverse the progressive course of MND. [26] Symptomatic treatments include the treatment of cramps, [27] pain, [28] spasticity, [29] noninvasive ventilation for supporting respiratory function, [30] and enteral tube feeding to support nutrition deficiencies. [31] The main complaint of our patient was progressive dysphagia and sialorrhea.…”