Pain management_factsheet-1page.qxd

3000 Steeles Av
3000 Steeles A en
ue East, Suite 200, Mar
kham, Ontario L3R 4T9
Tel. 905-248-2052
el. 905-248-2052 F
• ax: 905-248-2019
ax: 905-248-2019 T
• oll Free:1 800 267-4257
oll Free:1 800 267-4257 www
| Fact Sheet
Pain is one of the least acknowledged symptoms of Pain management depends on identifying (as closely as people living with ALS. More than 60 per cent of people possible) the source of pain so that treatments will be living with ALS will admit to experiencing significant pain, effective. Non-pharmacological treatments include prop- varying in terms of intensity and etiology.
erly fitted wheelchairs, reasonable exercise such as tai chior cycling, acupuncture and use of massage. These treat- • Neuropathic pain: arising as a direct consequence of a ments help patients maintain their quality of life, increas- lesion or disease affecting the somatosensory system, resulting in tingling, burning, numbness or shooting pains. There are a variety of different medications used to treat • Nociceptive pain: deep-seated pain, localized to a point pain, including antidepressants, anticonvulsants and anti- of injury, resulting in aching, throbbing or stiffness. epileptics, serotonin/noradrenaline reuptake inhibitorsand opioids among others. It is important to understand Types of pain for people living with ALS vary, and both the positive and adverse effects of medications, as treatments need to be tailored to the underlying source of well as the other factors that may influence someone to • A common source of pain originates from the loss of subcutaneous tissue (both fat and muscle), which is the deepest layer of skin that insulates the body and • Although originally developed for depression, they have protects organs and bones. This can cause significant been known to manage neuropathic pain for many years. pain in the bone or due to pinched nerves from Drugs such as Amitriptyline are used in low doses to combat hyper-salivation, a common side effect for • Immobility commonly results in deep aching pains, people living with ALS, as well as to treat frozen • Spasticity in people living with ALS can cause • Antidepressants may have adverse side effects such as clenched-muscle and straight-muscle spasms, creating constipation and causing confusion or encephalopathy. • Fasciculations, or muscle twitches, common in ALS, are usually painful as well as distressing to patients. • Drugs such as gabapentin (Neurontin) and Pregabalin • Joint pain by stiffness and scarring is created by (Lyrica) work to manage the pain from immobility and capsulitis, commonly referred to as frozen shoulder syndrome. This throbbing pain can affect sleep and • These drugs help with anxiety in some people, though limit mobility and activity in patients. It should be adverse effects include sleepiness, weight gain and in treated early and aggressively with range of motion rare cases papilledema and blurred vision, so it’s best to exercises before enlisting in medications such as steroid • Other types of pain may be secondary to the illness or related to medications needed to battle ALS.
ALS. Three letters that change people’s lives. FOREVER.
3000 Steeles Avenue East, Suite 200, Markham, Ontario L3R 4T9
Tel. 905-248-2052 • Fax: 905-248-2019 • Toll Free:1 800 267-4257 •
| Fact Sheet
Serotonin/Noradrenaline reuptake inhibitors: • Cannabinoids, or marijuana-based drugs, include Sativex, • These are a class of antidepressants, including the drugs a drug which mimics the plant, encompassing THC and Venlafaxine, also known as Effexor, and Duloxetine, This drug is effective, but currently under conditional • Effexor is good at controlling the highs and lows that approval in Canada for the treatment of multiple people living with ALS experience from changes in their sclerosis, not ALS. People living with ALS can use actual marijuana to treat a lack of appetite or nausea, as • Cymbalta is good at controlling depression and well as both neuropathic and nociceptive pain. There are many different methods of using this type of • These drugs are processed in the liver, which is a careful treatment which can be chosen based on the patient’s consideration when prescribing. They can also affect intimacy and sexual function, which makes many • The largest side effect of cannabinoids is the cognitive effect, which can make it more difficult for regular day-to-day functioning.
Opioids:• These are widely used in palliative care because they are Pain in ALS is frequent, but is one of the most useful for deep, bony pain which occurs when patients under-recognized symptoms. Patients do not often have unusual pressure points or frozen shoulder volunteer information about their pain if they are not asked about it specifically, but it is necessary to treat their • They are great for controlling pain but have many pain, as it interferes with the patients’ health, affecting adverse effects, including nausea, vomiting, dizziness their sleep, appetite and overall quality of life.
• A Fentanyl transdermal patch, while strong, can be used This fact sheet is reporting on current research and is meant for by bulbar patients and can help them avoid constipation.
informational purposes only. ALS Canada does not assume • A new Buprenorphine patch, called BuTrans, is a mild responsibility for the information contained within, nor does it opioid and a once a week patch, which has less side endorse any specific medication. Please seek the advice of a effects and may be very effective for bone pain. health-care professional for more information. • Morphine is another form of opioid, which can be used to treat pain, as well as the feeling of not getting Information provided by: Angela Genge, MD, director, Clinical Research Unit at enough air. Methadone may be used if Morphine is Montreal Neurological Institute and assistant professor, Department ofNeurology, McGill University. Other medications:• Tramadol works well for neuropathic and nociceptive pain, as well as mixed pain and can be taken by patients that are still mobile and only need it once in a while.
• A new lidocaine patch coming out soon will be useful in focal pain such as shoulder pain.
ALS. Three letters that change people’s lives. FOREVER.


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