The challenge of pain management in patients with myasthenia gravis

Simon Haroutiunian*, Shimon Lecht, Arik A. Zur, Amnon Hoffman, Elyad Davidson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations

Abstract

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction. The complexity of the disease and its treatments make MG patients particularly susceptible to adverse effects of drugs. MG is not a painful condition; however, as pain management armamentarium includes drugs from diverse pharmacological groups and with potential for drug-drug interactions, managing pain in patients with MG can be challenging. The underlying disease and the concomitant medications of each patient must be considered and the analgesic treatment individualized. This review presents an update on the various aspects of pain pharmacotherapy in patients with MG, focusing primarily on medications used to treat chronic pain. Drugs discussed are opioids, nonsteroidal anti-inflammatory drugs, antidepressants, anticonvulsants, muscle relaxants, benzodiazepines, intravenous magnesium, and local anesthetics. Drug interactions with agents used for MG treatment (acethylcholinesterase inhibitors, corticosteroids, immunosuppressants) and plasmapheresis are discussed. The clinical usefulness and limitations of each of the drug classes and agents are described.

Original languageAmerican English
Pages (from-to)242-260
Number of pages19
JournalJournal of Pain and Palliative Care Pharmacotherapy
Volume23
Issue number3
DOIs
StatePublished - 2009

Bibliographical note

Funding Information:
Simon Haroutiunian, BSc Pharm, MSc Clin Pharm, is a clinical pharmacy specialist in the Pain Relief Unit, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, and is a PhD fellow at Department of Pharmaceutics, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel. At the time of the submission of this paper, he was a Fulbright Doctoral Fellow in Translation Pain Pharmacotherapy Research at the University of Utah, Salt Lake City, USA. Shimon Lecht, BSc Pharm, MSc, is a senior PhD fellow in the Neurotoxicology Laboratory at Department of Pharmacology and Experimental Therapeutics, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel. Arik A. Zur, BSc Pharm, MSc Clin Pharm, is a PhD fellow at Department of Pharmaceutics, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel. Amnon Hoffman, PhD, is Professor and Chairman of the Department of Pharmaceutics and Head of Clinical Pharmacy Program, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel. Elyad Davidson, MD, is Lecturer and Director of the Pain Relief Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel. Address correspondence to Simon Haroutiunian, Department of Pharmaceutics, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem 91120, Israel (E-mail: simonh@ekmd.huji.ac.il). S.H. is supported in part by a Fulbright Doctoral Fellowship and S.L. is supported by an Eshkol Fellowship from the Israeli Ministry of Science, Culture and Sport. This paper is a part of the PhD dissertation to be submitted to The Hebrew University of Jerusalem by S.H. S.H. and S.L. equally contributed in the preparation of the manuscript.

Keywords

  • Acethylcholinesterase inhibitors
  • Adverse effects
  • Anticonvulsants
  • Antidepressants
  • Benzodiazepines
  • Corticosteroids
  • Drug-drug interactions
  • Immunosuppressants
  • Local anesthetics
  • Magnesium
  • Muscle relaxants
  • Myasthenia gravis

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