Characteristics of pain in amyotrophic lateral sclerosis

Abstract

Background: Pain is an often underestimated and neglected symptom in amyotrophic lateral sclerosis (ALS).

Methods: In a cross-sectional survey, 46 patients with ALS, 46 age- and gender matched population-based controls, and 23 diseased controls with myotonic dystrophy type 2 (DM2) were screened for occurrence, type, distribution, and treatment of pain and cramps. Data were collected with the use of the short form brief pain inventory (BPI).

Results: Pain was reported in 78% of ALS patients,79% of DM2 patients, and 54% of controls (P<0.05). More ALS patients than controls reported moderate to severe pain (42% vs. 20%). Pain in ALS patients interfered significantly more with daily activities than in controls (median pain interference score: 3.0 vs. 1.2, P<0.05), especially enjoyment of life (5.0 vs. 1.0) and mood (3.0 vs. 1.0). There was no correlation between the duration of the disease and the severity of pain. Movement-induced cramps were reported in 63% of ALS patients, mostly in the distal extremities. There was no difference in the duration of ALS disease between patients reporting cramps and those who did not.

Discussion: Our study showed that pain was a relatively frequent symptom which had an important impact on the quality of life. Pain that requires treatment can occur at every stage of ALS.

Keywords: Amyotrophic lateral sclerosis; cramps; motor neuron disease; pain; spasticity.

Figure 1

Sites of pain (in/across different parts of the body) in 36 patients with amyotrophic lateral sclerosis (ALS) (A) and in 25 controls (B) reporting pain in the last 24 h. Description of pain in 36 patients with ALS (C), 19 patients with DM2 (D), and 25 controls (E) reporting pain in the last 24 h. Sites of crampi (in/across different parts of the body) in 46 patients with ALS (F) and in 25 controls (G). Data for patients with DM2 were not available.