Frequency of reported pain in adult males with muscular dystrophy

Abstract

Introduction: The purpose of this study was to present and compare pain between adult males with Duchenne (DMD), Becker's (BMD), Limb-Girdle (LGMD) Facioscapulohumeral (FSHD) forms of Muscular Dystrophy (MD), and healthy controls (CTRL), using three different methods of assessment.

Methods: Pain was assessed using 1) a whole body visual analogue scale (VAS) of pain, 2) a generalised body map and 3) a localised body map.

Results: All types of MD reported more VAS pain than CTRL, with 97% of all MD participants reporting pain; however, no differences were reported between types of MD. The generalised body map approach identified more frequent pain in the shoulders of FSHD (93%) than other groups (13-43%), hips of DMD (87%) and LGMD (75%) than other groups (0-29%), and legs of all MD (64-78%) than CTRL (25%). The localised body map approach identified common areas of frequent pain across types of MD, posterior distal leg and distal back, as well as condition specific regions of frequent pain, for example posterior trapezius in FSHD, and anterior hip pain in DMD and LGMD.

Conclusions: Using a single pain value (VAS), increased pain was reported by adults with MD compared to CTRL, with no clear differences between different MD groups, suggesting pain is symptomatic of MD. The use of the generalised body map approach, and to an even greater extent the localised body map approach, identified specific areas of frequent pain relevant to each individual condition. These results indicate that whist the commonly used generalised approach can be used to identify broad anatomical regions, the localised approach provides a more comprehensive understanding of pain, reflective of clinical assessment, and should be utilised in future research.

Fig 1. Example body map schematics.

A = The example body map given to participants; B = Example of the generalised body map segmented for analysis; C = Example of the localised body maps segmented for analysis.

Fig 2. VAS Pain Box-Plots.

Ο = Outlier; DMD = Duchenne Muscular Dystrophy; BMD = Beckers Muscular Dystrophy; LGMD = Limb-Girdle Muscular Dystrophy; FSHD = Facioscapulohumeral Muscular Dystrophy; CTRL = Control; Kg = Kilograms; ^B denotes significant difference from BMD; ^LG denotes significant difference from LGMD; ^F denotes significant difference from FSHD. ^C denotes significant difference from CTRL.

Fig 3. Body maps.

Topographic presentation of reported pain frequency across four types of Muscular Dystrophy using a localised method. A = Anterior; B = Posterior; DMD = Duchenne Muscular Dystrophy; BMD = Beckers Muscular Dystrophy; LGMD = Limb-Girdle Muscular Dystrophy; FSHD = Facioscapulohumeral Muscular Dystrophy; CTRL = Control.