What causes pain in LEMS?
In LEMS, an autoimmune disease, the immune system attacks nerve cell endings at neuromuscular junctions, the point where nerve cells meet muscles. Due to this, electrical impulses from the nerves do not get transmitted to the muscles, which gradually waste away due to lack of activity.
Pain in LEMS affects the extremities, such as the hands and legs, with varying severity. Lower back pain along with pain in either the left or right thigh that hinders free movement is also common. Many patients also have difficulty in getting up from a seated position.
Patients’ poor gait puts a lot of strain on muscles of the back, lending an ‘overworked’ appearance. Often, the pain is attributed to various other diseases, such as neuropathies and myopathies. However, a proper evaluation of symptoms can confirm the presence of neuromuscular junction disorders such as LEMS, and help with the right course of treatment.
Due to the inadequate transmission of nerve impulses to muscles, muscle growth slows and walking and moving can be difficult and quickly lead to extreme fatigue. Severe pain may result from such exhaustion, impeding participation in wanted activities. Many patients also have pain when swallowing, which can affect their getting adequate nutrition.
Treatment for pain in LEMS
Pain in LEMS should not be neglected, and needs to be effectively managed so that daily activities can be carried out with minimal discomfort.
Physiotherapy can help in strengthening muscles and improving their range of motion. It is important to follow a regular physiotherapy schedule, so that muscle wasting and pain are minimized. Occupational therapy and speech therapy may also be useful.
Pain and improper gait can be addressed once full-fledged LEMS treatment starts. If disease symptoms are less severe, cholinesterase inhibitors such as pyridostigmine are usually sufficient. For more severe cases, immunosuppression therapy using prednisone or azathioprine may be required. Intravenous immunoglobulin (IVIG) is also effective in preventing the immune system from attacking the neuromuscular junctions, helping to ease pain.
Last updated: September 10, 2019
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