A patient with amyotrophic lateral sclerosis treated for pain with codeine

Abstract

We reported on a woman with amyotrophic lateral sclerosis (ALS). She noticed weakness of left upper limb at age 73, and was diagnosed with ALS. She showed dysarthria and dysphagia later. Those symptoms worsened. She and her family didn't wish life-sustaining treatments. She complained of pain at left arm and other parts. We administered Codeine Phosphate as a palliative care. 44 days later, she died. According to guidelines by Japanese and American academy of Neurology, opioids are recommended for pain accompanied with ALS. However, strong opioids are likely to induce respiratory arrest in the patients with advanced ALS and losing weight. As for Japanese patients with ALS, we should consider administration of weak opioids, codeins.