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

Dangers, Laurence; Laviolette, Louis; Georges, Marjolaine; Gonzalez-Bermejo, Jésus; Rivals, Isabelle; Similowski, Thomas; Morélot-Panzini, Capucine

doi:10.1136/thoraxjnl-2016-208544

Cited by 18 publications

(15 citation statements)

References 39 publications

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“…In addition, the age at the time of the requirement for transition to TIV was an important factor that influenced decision making. 35,36 The difference between ages at TIV(+) and TIV(−) was not significant, and the ALS patients tended to refuse TIV when they were older because NIV could prolong their survival.…”

Section: Discussionmentioning

confidence: 98%

“…Other studies reported that long‐term NIV support decreased QOL due to sleep problems and a decreased pain threshold, which may lead to the accumulation of social restrictions and physiopsychological burdens in patients as well as caregivers, causing hesitation to transition from NIV to TIV. In addition, the age at the time of the requirement for transition to TIV was an important factor that influenced decision making . The difference between ages at TIV(+) and TIV(−) was not significant, and the ALS patients tended to refuse TIV when they were older because NIV could prolong their survival.…”

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics of long‐term survival with noninvasive ventilation and factors affecting the transition to invasive ventilation in amyotrophic lateral sclerosis

et al. 2018

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of long‐term survival with noninvasive ventilation and factors affecting the transition to invasive ventilation in amyotrophic lateral sclerosis

et al. 2018

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“…Moreover, a recent study in ALS suggested that mechanical ventilation, while corrects hypoventilation and alleviates dyspnoea, might increase the susceptibility to pain in terms of reduced pain pressure threshold. 48 Dyspnoea is known to activate the diffuse nociceptive inhibitory control as demonstrated by its inhibitory effect on painful stimuli (e.g. laser evoked potentials) 49 and nociceptive spinal flexion reflex (e.g.…”

Section: Types Of Painmentioning

confidence: 99%

Pain in amyotrophic lateral sclerosis

Chiò

Mora

Lauria

2017

The Lancet Neurology

114

113

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Pain is a largely neglected symptom in amyotrophic lateral sclerosis (ALS) although reported in a majority of patients. It occurs at all stages of the disease and can be an onset symptom preceding motor dysfunction. Pain is correlated with a deterioration of the patient's quality of life and increased depression. In the later stages of ALS, the pain severity can be such as to require increasing use of sedative-analgesic drugs and is among the events predicting clinical deterioration and death. The site of pain depends on the pain type or underlying mechanism, i.e. painful cramps (lower limbs, hands), nociceptive pain (shoulders, joints, pressure sores) or neuropathic pain (feet, lower limbs). Given the multifactorial nature of pain in ALS, different treatments have been suggested, ranging from non-steroidal anti-inflammatory agents, drugs for neuropathic pain, opioids and, most recently, cannabinoids, to physical therapy strategies and preventive assistive devices. Further understanding of the pathophysiology is crucial to drive assessment in clinical trials of therapeutic strategies targeted at specific mechanisms and studies of individually tailored therapies.

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“…A strong correlation between dyspnoea and pain has been described in patients who are effectively relieved by NIV. Relieving dyspnoea by NIV in patients with ALS having respiratory failure is associated with decreased pressure pain thresholds …”

Section: Palliative Care and Discontinuation Of Nivmentioning

confidence: 99%

NIV in amyotrophic lateral sclerosis: The ‘when’ and ‘how’ of the matter

2019

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Non-invasive ventilation (NIV) has become an essential part of the treatment of amyotrophic lateral sclerosis (ALS) since 2006. NIV very significantly improves survival, quality of life and cognitive performances. The initial NIV settings are simple, but progression of the disease, ventilator dependence and upper airway involvement sometimes make long-term adjustment of NIV more difficult, with a major impact on survival. Unique data concerning the long-term adjustment of NIV in ALS show that correction of leaks, management of obstructive apnoea and adaptation to the patient's degree of ventilator dependence improve the prognosis. Non-ventilatory factors also impact the efficacy of NIV and various solutions have been described and must be applied, including cough assist techniques, control of excess salivation and renutrition. NIV in ALS has been considerably improved as a result of application of all of these measures, avoiding the need for tracheostomy in the very great majority of cases. More advanced use of NIV also requires pulmonologists to master the associated end-of-life palliative care, as well as the modalities of discontinuing ventilation when it becomes unreasonable. Respirology (2019) 24, 521-530 522 C Morelot-Panzini et al. ALS, amyotrophic lateral sclerosis; EPAP, expiratory positive airway pressure; I/E ratio, inspiratory time/expiratory time ratio; NIV, non-invasive ventilation; RR, respiratory rate; Ti, inspiratory time.Respirology (2019) 24, 521-530

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

Cited by 18 publications

References 39 publications

Clinical characteristics of long‐term survival with noninvasive ventilation and factors affecting the transition to invasive ventilation in amyotrophic lateral sclerosis

Clinical characteristics of long‐term survival with noninvasive ventilation and factors affecting the transition to invasive ventilation in amyotrophic lateral sclerosis

Pain in amyotrophic lateral sclerosis

NIV in amyotrophic lateral sclerosis: The ‘when’ and ‘how’ of the matter

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