Treatments for spasticity and pain in multiple sclerosis: a systematic review

Beard S, Hunn A, Wight J
Record ID 32003001206
English
Authors' objectives:

This review aims to assess what treatments are available for the management of pain and spasticity in multiple sclerosis (MS) and to evaluate clinical and cost effectiveness through assessment of the best available evidence.

Authors' results and conclusions: In the absence of formal research of any quality in this area, it is not possible to draw conclusions regarding the effectiveness or otherwise of the interventions identified. Evidence relating to the cost-effectiveness of treatments was extremely limited. In the review of spasticity, five health economic evaluations of intrathecal baclofen were identified. No studies relating to the remaining treatments were identified. The five studies suggested that although expensive, the use of intrathecal baclofen may be associated with significant savings in hospitalisation costs in relation to bed-bound patients who are at risk of developing pressure sores, thus enhancing its cost-effectiveness. No studies of cost-effectiveness were identified in the review of pain. There is evidence, albeit limited, of the clinical effectiveness of baclofen, dantrolene, diazepam, tizanidine, intrathecal baclofen and BT and of the potential cost-effectiveness of intrathecal baclofen in the treatment of spasticity in MS. Owing to the paucity and poor quality of evidence identified in this review, no further conclusions regarding the clinical or cost-effectiveness of the remaining interventions for pain or spasticity can be drawn.
Authors' recomendations: Many of the interventions identified are not licensed for the alleviation of pain or spasticity in MS. In addition, the lack of evidence relating to their effectiveness may militate against them being used consistently across the NHS. Lastly, the licensing and forthcoming availability of trial evidence relating to the use of cannabinoids in the alleviation of symptoms relating to MS may mean that we are in the ironic position of having better evidence of the effectiveness of new treatments than of any of the currently used drugs.
Authors' methods: Systematic review
Details
Project Status: Completed
URL for project: http://www.hta.ac.uk/1165
Year Published: 2003
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England
MeSH Terms
  • Multiple Sclerosis
  • Muscle Spasticity
  • Pain
Contact
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.