Abstract
Background: Although pain is common in amyotrophic lateral sclerosis (ALS) and an effectively treatable symptom, it is widely under-recognized and undertreated. This study investigates epidemiological and clinical characteristics of pain, its impact and pharmacological treatment in ALS patients. In addition, opportunities for further optimization of pain therapy need to be identified. Methods: Patients from three German ALS outpatient clinics were asked to complete the Brief Pain Inventory and the ALS Functional Rating Scale—Extension and to participate in semi-structured telephone interviews. Results: Of the 150 study participants, 84 patients reported pain. Pain occurred across all disease stages, predominantly in the neck, back and lower extremities. It was described with a broad spectrum of pain descriptors and mostly interfered with activity-related functions. Of the 84 pain patients, 53.8% reported an average pain intensity ≥4 on the numerical rating scale (NRS), indicating pain of at least moderate intensity, and 64.3% used pain medication. Irrespective of the medication type, 20.4% of them had no sufficient pain relief. Thirteen out of 30 patients without pain medication reported an average NRS value ≥4. Eleven of them—mainly in the context of high pain interference with daily functions—were supposed to benefit from adequate pain therapy. However, many patients had relevant concerns and misconceptions about pain therapy. Conclusion: Given the frequency, extent and multi-faceted impact of pain, it is necessary to systematically assess pain throughout the disease course. Potentials to optimize pain therapy were seen in the subset of patients with insufficient pain relief despite medication and in those patients without pain medication but high pain interference. However, there is a need to respond to patients’ barriers to pain therapy.
Highlights
IntroductionAmyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder with rapidly progressive muscle wasting and paralysis
This article is an open access articleAmyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder with rapidly progressive muscle wasting and paralysis
Our study demonstrates that pain is present at any stage of the disease, which is in agreement with a previous study that pointed to pain as a common symptom in amyotrophic lateral sclerosis (ALS)
Summary
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder with rapidly progressive muscle wasting and paralysis. Studies focusing on pain in ALS report considerably variable prevalence, ranging from 40% to 85% [4,5,6,7,8]. The reported pain intensity is highly variable, ranging from mild [5,6,9], to moderate [7,10] and up to severe [11]. Pain is common in amyotrophic lateral sclerosis (ALS) and an effectively treatable symptom, it is widely under-recognized and undertreated. This study investigates epidemiological and clinical characteristics of pain, its impact and pharmacological treatment in ALS patients. Opportunities for further optimization of pain therapy need to be identified
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