Pain in motor neuron disease.

Newrick, P. G.; Langton-Hewer, R

doi:10.1136/jnnp.48.8.838

Cited by 73 publications

(43 citation statements)

References 6 publications

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“…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] .…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2016

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Background: An increased frequency of psychotic disorders in amyotrophic lateral sclerosis (ALS) families compared to controls has been reported. Aim of our study was to assess the relationship between nervous system drugs prescriptions and subsequent onset of ALS in a large Italian population. Methods: The study population consisted of all subjects over 15 years at the 2001 Italian census, resident in Turin since 1996 (n = 687,324), followed up for ALS occurrence from 2002 to 2014. Exposure to nervous system drugs was measured until 2012, or until 1 year before ALS onset. The association was estimated for ever and cumulative exposure, through Cox proportional Hazards models adjusted for sex, age, education, marital status and drug co-exposure. Results: In the analysis for ever exposure, opioids were significantly inversely associated with ALS risk (hazard ratio (HR) 0.59; 95% CI 0.35-0.97), while antiepileptics (HR 1.35; 95% CI 0.92-2.00) showed a marginally significantly positive association. Examining cumulative exposure, the protective role of opioids associated with more than 4 prescriptions and the risk effect of antiepileptics for over 6 prescriptions was confirmed. Conclusions: The present study revealed associations of ALS onset with previous exposure to opioids, maybe through the activation of δ receptor and σ receptors and antiepileptics, which are novel findings to our knowledge.

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Section: Discussionmentioning

confidence: 96%

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

et al. 2016

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“…Although pain in ALS is not usual in the initial stages, 92 between 40 and 73% of patients experience pain in later stages. [93][94][95][96] It may be caused by stiff joints, muscle cramps, or pressure on the skin or joints from immobility. In one series, 55% of patients responded to combinations of antiinflammatory, antispasticity, and non-narcotic analgesic drugs.…”

Section: Dx: Alsmentioning

confidence: 99%

Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review) [RETIRED]

et al. 1999

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(AAN) is charged with developing practice parameters for physicians. This evidence-based review addresses some of the major management issues in patients with ALS, and highlights the many areas in which more research is needed.Justification. ALS is a progressive, degenerative motor neuron disease of unknown cause. Muscle atrophy and spasticity in limb and bulbar muscles result in weakness and loss of ambulation, oropharyngeal dysfunction, weight loss, and ultimately respiratory failure. Although advances in understanding the pathophysiology of ALS have stimulated the development of new drug therapies, 1 the mainstay of treatment for ALS patients remains symptomatic management.The practice parameters presented here comprise the first recommendations for the management of ALS based on a prescribed review and analysis of the peer-reviewed literature. These practice parameters were developed to improve the care and the quality of life of people with ALS by providing a rational basis for managing the disease.Description of the process. A multidisciplinary task force, all with extensive ALS experience, included 19 physicians, 3 patients with ALS, 1 gastroenterologist, 1 pulmonologist, 1 occupational therapist whose mother has ALS, and 1 nurse. In addition, consultants with expertise on ethics, practice parameter development, and medical library research participated in the process. The task force agreed to investigate five areas: 1) informing the patient and the family about the diagnosis and prognosis (also called "breaking the news") of ALS; 2) symptomatic treatment; 3) nutrition, and decisions about percutaneous endoscopic gastroscopy (PEG); 4) respiratory insufficiency and mechanical ventilation; and 5) advance directives and palliative care. To help achieve this goal, they developed several guiding principles or attributes of care: Principles of ALS management1. High priority should be placed on patient self-determination or autonomy as an underlying assumption in the therapeutic relationship. Delivery of both information and care must take into consideration the cultural and psychosocial context of the patient and the family. 2. Patients and families need information that is timed appropriately for decision making, and delivered well in advance of major management crossroads, especially for respiratory care. Moreover, decision making is a dynamic process that may be subject to change as the disease becomes more severe.The investigators and institutions of the ALS Practice Parameters Task Force are listed in the Appendix on page 1320.

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“…These symptoms are usually best treated with non-steroidal anti-inflammatory drugs and physiotherapy. Special attention must be given to nursing care, which requires frequent changes in the patient's position, both at night and during the daytime [16].…”

Section: Musculoskeletal Painmentioning

confidence: 99%

Palliative care in amyotrophic lateral sclerosis

1997

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The poor prognosis of amyotrophic lateral sclerosis (ALS) makes palliative care a challenge for the neurologist. Most disabilities associated with progressive disease can be ameliorated by symptomatic treatment. Prognosis and treatment options should be openly discussed with the patient and his/her relatives. Nutritional deficiency due to pronounced dysphagia can be efficiently relieved by a percutaneous enterogastrostomy. Respiratory insufficiency can be treated by non-invasive ventilation at home, provided the familial environment is supportive. Adequate assistance and palliative treatment in the terminal phase is of paramount importance.

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Pain in motor neuron disease.

Cited by 73 publications

References 6 publications

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

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

Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review) [RETIRED]

Palliative care in amyotrophic lateral sclerosis

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