Treatment of Pain in Patients with Multiple System Atrophy
Clinical Scenario
Pain is a recognized and often underappreciated complication in multiple system atrophy. It can arise from several distinct mechanisms, requiring a careful assessment of the underlying cause before selecting an appropriate management strategy.
Pain Presentations in MSA
Pain can be related to dystonia, spasticity, abnormal posture or deformities, and orthostatic hypotension. A characteristic example is neck pain occurring in the setting of the coat-hanger sign — pain distributed across the suboccipital, paracervical, and shoulder regions in a coat hanger–shaped pattern.
Treatment Approach (Overview)
The management strategy depends on the type of pain present. For dystonia-related pain, one category of targeted injection therapy may be considered; for other pain types, certain pharmacological agents are used.
The complete regimen — including agent selection, sequencing, and clinical decision criteria — is available in the full protocol.
References
DOI: 10.1212/cont.0000000000001598
- Pain can be related to dystonia, spasticity, abnormal posture or deformities, and orthostatic hypotension, such as neck pain in the setting of the coat-hanger sign (ie, pain in the suboccipital or paracervical and shoulder regions in a coat hanger–shaped distribution).
- Pain associated with dystonia may respond to botulinum toxin injections.
- Other types of pain in patients with multiple system atrophy may benefit from duloxetine, gabapentin, or pregabalin.
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