Shoulder pain in motor neuron disease: An under appreciated problem.

Shoulder pain appears to be a common and distressing, albeit under-reported symptom in Motor Neuron Disease [MND]. The precise aetiology and prevalence is unknown, but it appears to cause significant morbidity. Chronic pain often results in reduced Quality of life [QoL]. Pain from degenerative shoulder disease has been successfully managed with a supra-scapular nerve block. Our aims were to assess the prevalence and symptom burden in patients with MND, and management strategies utilized for pain relief, including patients acceptance of a nerve block for pain relief if required.

We conducted a postal survey of current patients from our MND service. Case note review was conducted in those patients who had not returned completed surveys. All data was de-identified for presentation.

Forty-seven questionnaires were posted with a response rate of 62%. The median age was 67 years [Range 43-83 years]. The median time since diagnosis was 11 months [Range 3-96 months]. 47% of respondents and case note reviews had experienced shoulder pain in the preceding 3 months. QoL was impaired with sleep disturbance and distress reported. Most patients had utilized several treatment modalities including opioids. 93% of respondents reported an acceptance of a nerve block if required for pain management.

Almost half of the patients in a specialized MND clinic describe shoulder pain as an issue, with reduced quality of life. Multiple treatment modalities are being utilized. A supra-scapular nerve block may prove advantageous. Unless specific enquiry is undertaken, significant shoulder pain may be missed in MND patients.