Chronic Pain in Persons With Neuromuscular Disease


Chronic Pain in Persons With Neuromuscular Disease

Jensen MP, Abresch RT, Carter GT, McDonald CM

Department of Rehabilitation Medicine,
University of Washington School of Medicine,
Seattle, WA

From the Full-Text Article:


The treatments that provided the greatest pain relief were not necessarily those that are most frequently used. The average relief rating, on a 0 to 10 scale, for chiropractic manipulation was 7.33 for the very few patients (4%) with pain who tried this treatment. Most of these patients reported that they were still receiving this treatment. No patients with severe pain reported ever having tried chiropractic care. Nerve blocks were reported as providing the next highest degree of relief among all the treatments (average relief rating, 6.75), although none of the patients who received these in the past were still receiving nerve blocks. Opioid analgesics were also listed as providing more relief than other pain treatments(average rating, 6.37) and were tried by about a third of the participants with pain overall. Interestingly, however, only about two thirds of those participants who tried opioids for pain were still using this treatment at the time of the survey. Other treatments that provided some pain relief, on average (relief rating =5.00 on the 0–10 scale), were ibuprofen and aspirin, massage, muscle relaxants, acupuncture, and hypnosis. Treatments that appeared to provide relatively little relief (relief rating, <4.00) were carbamazepine and magnets, although the former received a relatively high relief rating among those participants with severe pain who tried it (6.33). Across all treatments, there was a fair amount of variability (SD range, 2.50–4.76 for all respondents with pain) in the relief provided by the pain treatments.

Table 8 says it all:

Table 8   Percentage of Participants With Pain Who Have Tried Each Treatment, Percentage of Participants Who Still Use the Treatment, and Average Relief Rating Associated With Each Treatment
Pain treatment All Subjects With Pain (n=141) Subjects With Severe Pain (n=38)
% Tried/% Still Use Average Relief ±SD † % Tried/% Still Use Average Relief±SD †
Chiropractic manipulation 4/85 7.33±3.78 0/NA ND
Nerve blocks 3/0 6.75±4.76 5/0 10.00±0.0
Narcotics 35/63 6.37±2.74 42/56 5.75±2.79
Muscle relaxants 18/60 5.78±2.88 21/50 4.25±1.26
Massage 34/44 5.48±2.73 34/39 4.91±3.36
Acupuncture 11/25 5.29±3.22 3/100 6.00±0.00
Ibuprofen, aspirin 61/65 5.22±2.83 47/78 4.25±3.05
Hypnosis 2/3 5.00±4.24 0/NA ND
Neurontin 18/50 4.78±3.02 24/56 4.57±3.05
Counseling 9/67 4.70±2.50 18/71 4.17±2.64
Physical therapy 43/42 4.54±2.66 50/37 3.89±2.25
Tricyclic antidepressants 15/38 4.53±3.28 18/29 5.43±2.99
Biofeedback/relaxation training 8/55 4.42±2.50 11/75 4.50±1.91
Acetaminophen 47/58 4.11±2.93 37/50 3.31±2.87
Carbamazepine 4/17 3.80±4.38 8/33 6.33±3.79
Magnets 11/25 3.13±3.16 11/25 1.75±2.87

Abbreviation: NA, not applicable; ND, no data.

The Abstract:

Objective:   To examine the nature and scope of pain in persons with neuromuscular disorder (NMD).

Design Survey:   Setting University-based rehabilitation research programs.

Participants:   Adults with NMD (N=193).

Interventions:   Not applicable.

Main Outcome Measures:   Pain presence or absence, pain severity, pain quality (Neuropathic Pain Scale), pain interference (Brief Pain Inventory), pain site, quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and pain treatment. Results Seventy-three percent of the sample reported pain, with 27% of these reporting that this pain was severe (>/=7 on a 0-10 scale), on average. “Deep,” “tiring,” “sharp,” and “dull” were the words used most frequently to describe NMD pain. Patients with amyotrophic lateral sclerosis and myotonic muscular dystrophies reported the greatest pain interference, and patients with Charcot-Marie-Tooth the least, among all NMD diagnoses. The most frequent pain site, overall, was back (49%), followed by leg (47%), shoulder (43%), neck (40%), buttock and hip(s) (37%), feet (36%), arm(s) (36%), and hand(s) (35%). The study participants reported significantly greater dysfunction than subjects in the SF-36 normative sample (persons without health problems) on a number of the SF-36 scales. However, we found no significant differences between the study participants and the US norms on the SF-36 role-emotional or mental health scales. A number of pain treatments were used by the study sample, but no treatment appeared to be effective for all participants, and some of the treatments reported as most effective (eg, chiropractic care) were used by very few participants.

Conclusions:   Pain is a common problem among patients with NMDs. There are many similarities, but also some important differences, between NMD diagnostic groups on the nature and scope of pain and its impact. More research is needed to identify and test effective treatments for NMD-related pain.