making muscle wasting history

I think the lack of dystrophin has two effects (i) it reduces eNos at the neuromuscular junction (ii) it prevents cramps.

Boys with BMD "seem" to have more cramps than DMD boys - because dystrophin means they can have cramps - I think DMD boys can't have strong cramps because strong cramps require dystrophin.

I also think that pain signals are not sent as easily from DMD boys muscles to the nerves because the eNos in the muscles is not formed properly because dystrophin is missing. I think once the boys starts to have their dystrophin restored pain will be a bigger problem.

I also think that care needs to be chosen for the drugs because there is a good chance that pain management drugs could improve or worsen the condition. For example if anti-inflammatory drugs were given.

Clinicians need to pay more attention to pain in the boys, more attention to the causes of pain.

A recommendation in a recent paper published called "Pain in Youths With Neuromuscular Disease" was.

http://www.ncbi.nlm.nih.gov/pubmed/19820205

"These data strongly support making comprehensive pain assessment and management an integral part of the standard of care for youths with NMD"