What medications are given for Amyotrophic Lateral Sclerosis (ALS) to manage muscular skeletal pain due to spasticity?

From the Guidelines

For ALS patients experiencing muscular skeletal pain due to spasticity, oral baclofen and tizanidine are commonly prescribed medications to manage spasticity and alleviate pain 1.

Medication Options

• Baclofen: can be used to help relax muscles and reduce spasticity, with consideration for use as stated in the guidelines 1.
• Tizanidine: can be used to reduce muscle tone and alleviate spasticity, specifically for chronic conditions as mentioned in the guidelines 1.
• Dantrolene: is also considered for spasticity resulting in pain, poor skin hygiene, or decreased function, as per the guidelines 1. It's essential to note that the dosage and duration of treatment may vary depending on individual patient needs and response to treatment, and these medications may have potential side effects, with diazepam or other benzodiazepines generally recommended against due to possible deleterious effects on recovery and sedation side effects 1.

From the FDA Drug Label

Baclofen tablets are useful for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. Diazepam is a useful adjunct for the relief of skeletal muscle spasm due to reflex spasm to local pathology (such as inflammation of the muscles or joints, or secondary to trauma), spasticity caused by upper motor neuron disorders (such as cerebral palsy and paraplegia), athetosis, and stiff-man syndrome

The medications given for muscular skeletal pain due to spasticity are:

• Baclofen for the alleviation of signs and symptoms of spasticity, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity 2
• Diazepam as a useful adjunct for the relief of skeletal muscle spasm due to spasticity caused by upper motor neuron disorders 3 However, neither label explicitly mentions Amyotrophic Lateral Sclerosis (ALS), so no conclusion can be drawn about the use of these medications specifically for ALS.

From the Research

Medications for Managing Muscular Skeletal Pain due to Spasticity in ALS

• Centrally acting agents such as baclofen, clonidine, and tizanidine are used to treat spasticity 4
• Anticonvulsants like benzodiazepines and gabapentin can also be used to manage spasticity 4
• Peripherally acting agents like dantrolene may be used to treat spasticity 4
• Intrathecal baclofen (ITB) pump placement can be used to manage spasticity-related pain in ALS patients 5

Efficacy of Medications

• ITB has been shown to reduce pain associated with spasticity in ALS patients, with an average reduction of 54% in pain scores 5
• The degree of pain reduction following preoperative ITB test injection can predict postoperative pain reduction 5

Limitations of Current Research

• There is a lack of randomized controlled trials evaluating the efficacy of medications for spasticity in ALS patients 6, 7, 8
• More research is needed to determine the effectiveness of various treatments for spasticity in ALS patients 6, 7, 8