The challenge of pain management in patients with myasthenia gravis

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

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations


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 languageEnglish
Pages (from-to)242-260
Number of pages19
JournalJournal of Pain and Palliative Care Pharmacotherapy
Issue number3
StatePublished - 2009


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


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