Pathogenesis and management of pain in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease is characterized by deadly progressive motor neuron disease and other neuronal cells death, which is featured by progressive paralysis and leads to advanced disability and mortality due to respiratory failure.^1,2 By the year of 2040, ALS is estimated to nearly double due to global population aging.³ Pain is one of the overlooked symptom, but widely complained by patients with ALS. It can arise at any stage of the disease; and the intensity of pain may increase with the course of the disease. The pain characteristic depends upon its pathogenesis in inducing pain such as nociceptive, neuropathic, or painful cramps. Pain intensity can be severe at an advanced stage of ALS thereby increasing the use of pain relievers and sedatives. It has been related to a declined functional status leading to a decreased quality of life and escalating the rate of depression. Management in ALS patients with complaints of pain differs according to the multifactorial character of pain.^4,5 The different aspects of pain in ALS has not been much discussed. Therefore, this article will provide an overview about it.