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Next Reply: Re:Muscular Dystrophy
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Post Muscular Dystrophy
Author: MichaelChristensen
Date: Feb 23, 2012 7:04 pm

I'm working in a rural setting with a cohort of children and adults with muscular dystrophy. I am looking for a good reference for pain management (opiate and non-opiate) for this population. Any ideas? Thanks.

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Re:Muscular Dystrophy (by TerryAltilio on 02/29/2012)
I am a social worker in the Department of Pain Medicine and Palliative Care at Beth Israel and ran this question by Dr Russell Portenoy who has done extensive work in pain and palliative care.He suggested reaching out to Dr Engel, first author of the following paper, who has published several things in this area and would know if there is an up-to-date review or specific guideline. Hope this is helpful.

Am J Hosp Palliat Care. 2009 Oct-Nov;26(5):405-12.

Pain in youths with neuromuscular disease.
Engel JM, Kartin D, Carter GT, Jensen MP, Jaffe KM.

SourceDepartment of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA. jmengel@u.washington.edu

Abstract
To examine the prevalence and characteristics of pain in children with neuromuscular disease (NMD), 42 youths with NMD underwent a comprehensive evaluation including a detailed intake interview and structured questionnaire that included demographic and functional data. Youths who reported chronic pain were further queried about pain characteristics, locations, and intensity using an 11-point numerical rating scale and a modified Brief Pain Inventory (BPI). The sample consisted of 24 males (57%) and 18 females (43%), ages ranging from 9 to 20 years (M = 14.8, SD = 2.96). Participants included 14 (37%) with Duchenne muscular dystrophy, 6 (14%) with myotonic dystrophy, 2 (5%) with Becker dystrophy, 2 (5%) with limb-girdle dystrophy, 2 (5%) with congenital muscular dystrophy, 1 (2%) facioscapulohumeral, and 15 (36%) were classified as ''other NMD.'' Twenty-one (50%) were ambulatory; 26 (62%) used power wheelchairs/scooters, 9 (2%) used manual wheelchairs, 3 (.07%) used crutches/canes, and 1 (2%) used a walker. A total of 23 (55%) of the youths reported having chronic pain. Current pain intensity was 1.30 (range = 0-6), mean pain intensity over the past week was 2.39 (range = 0-7), mean pain duration was 8.75 hours (SD = 12.84). Pain in the legs was most commonly reported and 83% reported using pain medications. This study indicates that chronic pain is a significant problem in youths with NMD. These data strongly support making comprehensive pain assessment and management an integral part of the standard of care for youths with NMD.----

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