The role of mental health and self-efficacy in the pain experience of patients with amyotrophic lateral sclerosis

Abstract

Complex interactions between pain, depression, and anxiety impact quality of life in patients with ALS. Psychological approaches to pain control may be useful. This study explored the role of self-efficacy in mitigating pain. Individuals registered with the Agency for Toxic Substances and Disease Registry National ALS Registry and who experienced pain were invited to participate in an online survey. Subjects completed the Brief Pain Inventory-Short Form, Hospital Anxiety and Depression Scale, and Chronic Pain Self-Efficacy Scale. Correlations between variables were determined. Multiple linear regression models assessed relationships between depression, anxiety and self-efficacy predictions, and pain severity, interference, and relief. Results recorded that there were 197 participants (58% males, mean age 59 AE 10 years). Cases or borderline cases of depression or anxiety were common. Mean levels of pain were moderate. Higher pain self-efficacy scores predicted lower pain severity, lower pain interference, and higher pain relief with treatment. As depression scores increased, pain interference with daily life was higher. In conclusion, anxiety and depression are common in patients with ALS and pain. Self-efficacy appears to mitigate pain. A multifactorial approach to pain management should be considered in these patients, addressing mental health and self-efficacy to augment pharmacologic pain treatments.

National Study of Muscle Cramps in ALS in the USA

“…(4) The moderate severity of cramps in this series (5.2/10) is comparable to the prior single center study where most rated their pain as “moderate” and two ALS cramp treatment trials; 4.0/10(14) and 63.5/100(15). The average cramp frequency the patients in our study reported was 5.3 per day, which is higher than the 46 per month reported in the natural history study, being more comparable to the frequencies reported in treatment trials; 5.9(14) and 4.0(15).…”

“…(4) Cramps have been reported by 67 to 95 percent of ALS patients. (1, 5) A recent study focused on understanding pain in ALS showed that of those patients who report pain, 67% attribute their pain to cramps alone.…”

“…(1, 5) A recent study focused on understanding pain in ALS showed that of those patients who report pain, 67% attribute their pain to cramps alone. (4) Despite this common occurrence of cramps in ALS only a single center natural history study by Caress et al has been published. (5) This study which captured two or more time points of 33 patients is the most comprehensive study to date and it has the highest reported cramp frequency of 95 percent.…”

Amyotrophic Lateral Sclerosis Incidence and Previous Prescriptions of Drugs for the Nervous System

“…A possible direct detrimental effect of antiepileptic drugs on ALS onset cannot be excluded, although neuroprotective effects of gabapentin and valproic acid have been found in ALS mouse models [20,21] , which were confirmed in clinical trials on humans [22,23] . The detrimental effect led us to suppose also that ALS patients were treated with these drugs because they experience neuropathic pain during the onset period, as reported in previous studies [24][25][26] .…”

Pain in amyotrophic lateral sclerosis

“…Депрессивные нарушения отмечаются почти у половины больных БАС -в 47% случаев, из них бóльшая часть (до 30%) принимают антидепрессанты [39,40]. Показано, что при сопутствующей депрессии болевой синдром у таких пациентов наблюдается достоверно чаще, верно и обратное взаимоотношение [39,41]. Развитие аффективных расстройств, с одной стороны, обусловлено осознанием наличия неизлечимого и неуклонного прогрессирующего заболевания [39,40], а с другой -связано с различными патофизиологическими механизмами [17], недостаточно изученными на сегодняшний день.…”