From the Research
Multiple system atrophy (MSA) can cause pain, which is a frequent yet poorly characterized symptom, affecting 87% of MSA individuals, with the most common areas of pain being the neck and shoulders, back, and legs. Pain management in MSA requires a multifaceted approach, considering the high prevalence of pain and its significant impact on quality of life, as reported in a recent community-based survey 1.
Key Considerations for Pain Management in MSA
- First-line treatments for neuropathic pain include medications such as gabapentin or pregabalin, with dosages adjusted according to tolerance and response.
- Musculoskeletal pain management involves physical therapy, regular stretching, and sometimes muscle relaxants like baclofen or botulinum toxin injections for focal dystonia.
- Visceral pain often responds to treatments targeting underlying autonomic dysfunction, such as fludrocortisone for orthostatic hypotension or anticholinergics for bladder dysfunction.
- Non-pharmacological approaches, including heat therapy, massage, and adaptive equipment, are important adjuncts to pharmacological treatments.
Importance of Multidisciplinary Care
Pain management in MSA should be coordinated within a multidisciplinary team, including neurologists, pain specialists, and physical therapists, with regular reassessment as the disease progresses and symptoms evolve, as highlighted by the need for improved pain detection and treatment strategies in MSA 2.
Current State of Pain Management in MSA
Despite the high prevalence of pain, current management strategies remain suboptimal, with only 53% of respondents reporting at least partial satisfaction with their current pain management, underscoring the need for optimized management of MSA core motor and non-motor features to address pain effectively 1.