Efficacy of pain management strategies in adults with Amyotrophic Lateral Sclerosis (ALS): A Systematic Review

Symptom Management

• What can help with pain?

  !Qualifies this

  “Pain is common in people with ALS/MND.”

  Pain rates in ALS are reported from about 15 to about 85 percent across studies, so pain is clearly common but the figure is unsettled. The review also describes growing evidence of sensory involvement in ALS, including loss of small nerve fibres in the skin in most patients, and treats nerve pain as one primary cause rather than only a result of weakness.

  Intraepidermal nerve fiber loss is a feature of most ALS patients.

  Introduction

• What can help with pain?

  !Qualifies this

  “Pain in ALS/MND can often be eased, although the treatments used have not been well tested in ALS/MND specifically.”

  Supports the caution and does not establish the first half. It found only five randomised trials of pain treatment in ALS in ten years, none with pain as its main outcome. Most of the few treatments tested showed no pain benefit, and the approaches used in everyday practice were not tested at all, so the expectation that pain can often be eased rests on practice, not trials.

  Clinical trials focusing on pain management strategies for ALS patients are limited.

  Abstract

• What symptoms can be managed in ALS/MND?

  !Qualifies this

  “Pain in ALS/MND is not inevitable, and it can be managed.”

  Supports the first half and unsettles the second. Reported pain rates in ALS run from about 15 to about 85 percent, so pain is clearly not universal. But the review found only five randomised trials of pain treatment in ALS in ten years, none with pain as its main outcome, and earlier reviews found none. How well pain can be relieved is not established by trials.

  Clinical trials focusing on pain management strategies for ALS patients are limited.

  Abstract