Management
As MND is incurable, pharmacological treatments and other interventions are based mainly on managing symptoms. Several medicine recommendations are off label.1
Quinine is recommended as a first-line option for muscle cramps, with baclofen as a second-line option. Other options are tizanidine, dantrolene or gabapentin. Treatments for muscle stiffness include baclofen, tizanidine, dantrolene or gabapentin, but referral to a specialist may be necessary.1,16
Other approaches are a muscle relaxant such as diazepam or, for large muscles, an intramuscular injection of botulinum toxin. Muscle weakness may be a side effect of statins, so consider their discontinuation.16
Motor neurones themselves are not pain transmitters but pain can occur, usually in the limbs due to loss of movement. A patient with MND may be preoccupied with muscle weakness meaning pain may be overlooked in a consultation, so check if pain is occurring. Input from an appropriate therapist such as a physiotherapist, occupational therapist or psychologist will be beneficial.16
Analgesics can start with paracetamol or non-steroidal anti-inflammatories (NSAIDs) with a long-acting NSAID suggested for joint pain. Opiates (eg morphine, buprenorphine or fentanyl patches) can be used for analgesia and with careful dose titration can also be useful for symptomatic treatment of dyspnoea and coughing.16
Suggestions for neuropathic pain (arising from damaged nerves) are amitriptyline, duloxetine, gabapentin or pregabalin.16