Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy.
Multidisciplinary Department of Medical, Surgical and Dental Specialties, University of Campania "L. Vanvitelli", Naples, Italy.
Behav Neurol. 2024 Mar 16;2024:1228194. doi: 10.1155/2024/1228194. eCollection 2024.
Amyotrophic lateral sclerosis (ALS) is the most frequent neurodegenerative disease of the motor system that affects upper and lower motor neurons, leading to progressive muscle weakness, spasticity, atrophy, and respiratory failure, with a life expectancy of 2-5 years after symptom onset. In addition to motor symptoms, patients with ALS have a multitude of nonmotor symptoms; in fact, it is currently considered a multisystem disease. The purpose of our narrative review is to evaluate the different types of pain, the correlation between pain and the disease's stages, the pain assessment tools in ALS patients, and the available therapies focusing above all on the benefits of cannabis use. Pain is an underestimated and undertreated symptom that, in the last few years, has received more attention from research because it has a strong impact on the quality of life of these patients. The prevalence of pain is between 15% and 85% of ALS patients, and the studies on the type and intensity of pain are controversial. The absence of pain assessment tools validated in the ALS population and the dissimilar study designs influence the knowledge of ALS pain and consequently the pharmacological therapy. Several studies suggest that ALS is associated with changes in the endocannabinoid system, and the use of cannabis could slow the disease progression due to its neuroprotective action and act on pain, spasticity, cramps, sialorrhea, and depression. Our research has shown high patients' satisfaction with the use of cannabis for the treatment of spasticity and related pain. However, especially due to the ethical problems and the lack of interest of pharmaceutical companies, further studies are needed to ensure the most appropriate care for ALS patients.
肌萎缩侧索硬化症（ALS）是最常见的运动系统神经退行性疾病，影响上下运动神经元，导致进行性肌肉无力、痉挛、萎缩和呼吸衰竭，从症状出现到死亡的预期寿命为 2-5 年。除运动症状外，ALS 患者还有多种非运动症状；事实上，目前它被认为是一种多系统疾病。我们的叙述性综述的目的是评估不同类型的疼痛、疼痛与疾病阶段的相关性、ALS 患者的疼痛评估工具以及现有的治疗方法，重点是大麻使用的益处。疼痛是一种被低估和治疗不足的症状，近年来受到更多研究关注，因为它对这些患者的生活质量有很大影响。疼痛的患病率在 15%到 85%的 ALS 患者之间，关于疼痛类型和强度的研究存在争议。缺乏在 ALS 人群中验证的疼痛评估工具以及不同的研究设计影响了对 ALS 疼痛的了解，从而影响了药物治疗。几项研究表明，ALS 与内源性大麻素系统的变化有关，大麻的使用可能由于其神经保护作用而减缓疾病进展，并作用于疼痛、痉挛、抽筋、流涎和抑郁。我们的研究表明，患者对大麻治疗痉挛和相关疼痛的满意度很高。然而，特别是由于伦理问题和制药公司缺乏兴趣，需要进一步研究以确保为 ALS 患者提供最合适的护理。
