Identify The Cause Of The Pain
The first step in treating pain is to try to identify the cause. As I noted in the last essay, there are many different causes of pain for people with PD. If we look at the most common pain problems, low back and neck pain, we can see that there are many different causes for each. Many doctors order x-rays of the spine for these conditions, and they may be needed. The main problem with x-rays of the spine is that they always show arthritis, which is because virtually everyone over the age of 60 has arthritis in the spine. Whether thats the cause of the pain or not is usually not clear.
However, x-rays will show if theres a compression fracture , or a tumor. Since older women frequently develop compression fractures even without a fall, this can be important because we know then that the pain is likely severe, but time limited, and will resolve in a month or two. This makes it easier to treat with strong medication, like narcotics, because there is less concern for addiction. X-rays do not show discs, but disc herniation is much less common in older people so its of less concern.
Chiropractors focus entirely on spine pain and may be very helpful. Since many medical doctors are not very familiar with PD, I assume that many chiropractors probably arent either. Therefore it will be helpful to find one who is familiar with PD. Probably the best way to do this is through a Parkinsons Disease support group in your area.
Pain In Parkinson’s Disease
Doctors categorize pain as nociceptive, which refers to pain from tissue damage, or as neuropathic, which refers to pain that arises from the nerves. Some pain is both nociceptive and neuropathic. Most people with PD experience nociceptive pain.
This type of pain is generally localized to a specific area of the body. The most common areas for people with PD to experience pain are the neck, upper back, and the extremities . Neuropathic pain is less common in PD, although it may be caused by akathisia, an extreme restlessness.1
The pain caused by PD can generally be classified by one of five causes:
The Nervous System And Parkinson’s Disease
the hands and fingers, and their use or lack thereof, have key roles either in the rate of degeneration or in progressive symptom reduction. Indeed, if you’ve ever seen one of those grotesque renderings of how the human body is actually represented by the proportion of brain power devoted to each body part , the hands come out as absolutely massive – hands and neurology are very strongly linked!
Therefore hand exercises and finger stimulation are critically important for preventing the ravishes of neuronal atrophy in PD, and also to strengthen “para-sympathetic tone”, enhancing the ability to maintain a relaxed state, so important for people affected by the disease. Indeed, the story of Chris Lacey is intriguing, with reports he is now free from PD symptoms after intensive carving of chess pieces as a hobby.
The importance of hands and fingers is hence profound for those of us who have been diagnosed with chronic disease.
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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal; and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
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What Is Special About Parkinsons Syndrome Sufferers
Parkinsons Syndrome is a condition where the important nuclei below the brain become dysfunctional resulting in impaired communication and transmission of nerve impulses to and from nerve fibres throughout the body. Consequently some cognitive processes, eyesight focus, muscle control or strength may deteriorate. This often presents in a haphazard fashion with increasing stiffness of the joints and muscles and intention tremor most noticeable in the hands. Fine movements and writing ability deteriorate, The gait deteriorates as seem as a shuffling pattern with small steps with a quickening of gait as power is mustered and spasm is overcome, Whilst there is a downhill trend the process of deterioration may arrest for periods.
Seldom does this process directly generate nerve pain such as sciatica. Back or Neck pain and pain referred in to the arm or leg may arise in Parkinsons Syndrome Sufferers as part of the Degenerative Disc Disease seen in the rest of the population and with the same pathologies; disc protrusions, nerve entrapment / scarring / tethering, Lateral Recess Stenosis, Axial Stenosis, Spondylolytic Spondylolisthesis, vertebral slippage, Instability, Failed Back Surgery or failed chronic pain management.
Parkinsons Linked To Lower Back Pain A Study Reveals
According to a study, patients with Parkinsons disease have a higher incidence, longer duration, and greater severity of low back pain than individuals without the disease.
The research also indicated that Parkinsons patients with low back pain have a greater disability more severe motor impairments.
A common non-motor symptom of Parkinsons disease is pain, which has long been regarded as one of the most troublesome. Skeletal and joint deformities are possible causes of pain in Parkinsons patients. In particular, the lumbar region is more involved in musculoskeletal pain in these individuals.
Specifically, back pain seems to be a common and early symptom in Parkinsons disease, and patients appear to be more troubled by chronic low back pain than other symptoms, possibly due to a combination of altered posture, abnormal muscle tone, and truncal dystonia.
An observational study was conducted to explore the association between lower back pain and Parkinsons by analysing its prevalence, its underlying skeletal changes in the spine, and the relationship between spinal deformities and Parkinsons-specific symptoms.
Results indicated that lower back pain was significantly more frequent and lasted longer in Parkinsons patients than in other participants . Additionally, in patients with low back pain, the pain was more frequently located in the lumbar region, while pain intensity in this region was also higher in Parkinsons patients.
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
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My Parkinson’s Story: Pain
This 10-minute video alternates between an interview with a man and and doctors. The man shares his experience with pain as a symptom of Parkinson’s disease. The doctors explain that pain is common in Parkinson’s disease, often due to rigidity or dystonia, which can be exacerbated by “off” periods. Pain caused by Parkinson’s symptoms can be relieved by Parkinson’s medications, exercise, DBS and botox injections. Pain is an invisible symptom that should be mentioned to your neurologist.
Since A Back Injury In 1985 John Has Experienced Multiple Types Of Pain Some Of Which Have Been Triggered By His Parkinson’s He Was Diagnosed With The Condition In 2016
Ive been experiencing varying degrees of pain since injuring my back, which caused me to have lower-back pain, which continues to this day. Since then, I have also developed pain in other parts of my body due to Parkinsons, including my hands, ribs, upper back and shoulder.
The pain in my ribs is deep, aching and constant, and I get internal tremors in this area. However, the pains in my legs are sharp, intermittent and become very rigid, especially in my calves.
When I walk, the pain can get so bad that I end up having to stop and rest. On really bad days, I use a wheelchair. When Im in a lot of pain, it affects my Parkinsons symptoms even more, and also my spatial awareness, that I tend to lose my balance and fall or freeze.
I was referred to a pain specialist…who enrolled me on an 8-week pain management course led by a Parkinson’s-trained physiotherapist. Now I do an hour of gentle movements and stretching every morning.
I cant stand for long enough to wash and have a shave, or to wash the dishes, so I use a perching stool. I can no longer carry out my hobby of canoeing to the same degree. While I use to be able to do it all day, I’m now lucky if I can do it for an hour.
I was referred to a pain specialist, who prescribed me medication, and advised on workable changes to my lifestyle and diet. They also enrolled me on an 8-week pain management course led by a Parkinson’s-trained physiotherapist. Now I do an hour of gentle movements and stretching every morning.
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Physical Therapy In Linwood For Hip
Welcome to Parkinson Life Center of Southern New Jersey’s patient resource about Trochanteric Bursitis of the Hip.
A common spot for bursitis is on the side of the hip. Here a large tendon passes over the bony bump on the side of the hip. The bony bump is called the greater trochanter. Inflammation in the bursa between the tendon and the greater trochanter is called trochanteric bursitis. This problem is common in older individuals. It may also occur in younger patients who are extremely active in exercises such as walking, running, or biking.
This guide will help you understand the following:
- how trochanteric bursitis develops
Approaches To Pain Assessment
When assessing pain in patients with PD, using a validated pain scale that targets symptoms specific to PD whenever possible will more accurately categorize pain type. The first pain tool designed specifically for patients with PD is the Kings PD Pain Scale .4,12 This scale has 14 questions that measure severity and frequency of different types of pain specific to PD. A complementary patient screening tool, the Kings College PD Pain Questionnaire , is designed for assessing whether or not specific pain types are present. All questions on the KPPQ correspond with a specific question on the KPPS. Screening patients with the KPPQ can facilitate identifying pain types that correspond to the KPPS assessment tool.
If unable to assess pain with scales specific to PD, validated general pain scales, such as the Likert scale, can be utilized to determine quality and severity of any type of pain.18 Using PD-specific pain scales may better characterize a patients pain symptoms, however, which may lead to more targeted treatment options.
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Nerves And Nervous System
The vagus nerve is not the only important nerve which passes through the neck. According to the polyvagal research of Dr Stephen Porges, five of the cranial nerves form the parasympathetic ventral vagus complex, responsible for Social Engagement functions. Interestingly, this vagal complex includes the accessory nerve, that innervates the neck muscles used to turn the head. In his early paper on polyvagal theory, Dr Porges writes:
“Thus, more specialized functions such as head rotation to orient sensory receptors toward the source of stimulation, mastication to ingest food, and salivation to initiate gustatory and digestive processes are integrated into the vagal system.”
“In mammals, the part of the brain where these nerves originate controls the complex coordination of pharynx, soft palate, larynx, and esophagus. Of special note to psychophysiological processes the carotid body, containing peripheral chemosensitive receptors sensitive to oxygen and carbon dioxide levels”
“In addition, the accessory nerve provides fibers originating in the cervical spinal cord that innervate the positioning of the neck. The critical carotid arteries, internal jugular veins, and vagus nerves run deep in these muscles.”
“Thus, this complex also has the ability to orient visceral receptors via somatic muscles , to coordinate structures related to ingestion and expulsion, and to regulate facial expression and emotion.”
Treatment Depends On Properly Identifying The Type
If pain is bilateral always assume it is central pain; pain due to PD. In my experience Azilect works great for this type of pain. Other medications which can be employed for this pain as well.
Massage therapy works for all types of leg pain-my favorite therapy but can be costly. Water therapy may also work for all types except central pain. Physical therapy can alleviate dystonia pain, as well as musculoskeletal and radicular pain.
If pain is due to dystonia related to levodopa intake, find out when it occurs—end of dose or at peak dose. Typically adjusting medication doses will resolve problem. However, if dystonia is an initial symptom of PD, initiating treatment with levodopa will resolve. If medication adjustment does not work well for levodopa induced dystonia, another treatment option is DBS . Pain due to dystonia independent of cause can also respond well to Botox injections, as well as centrally acting muscle relaxants. To avoid and alleviate pain caused by stiff muscles, a great treatment option is activity in the form of stretching exercises—any number of activities will do such as tai-chi or yoga. For me when I start having radicular pain shooting down my leg it is time to up my levodopa dosage.
If you are having leg pain make sure to discuss it with your physician.
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Understanding The Lower Back Pain
The lower back pain is a classic. Most people associate it with an unhealthy lifestyle, the lack of physical activity or their jobs. Sitting in a chair for eight hours continuously can cause such problems, not to mention physically demanding jobs. From a different point of view, the backup of stool in the area might be responsible for the discomfort associated with the lower back as well.
If the lower back is severe and you also experience constipation, causes might be a bit more diversified. You might have suffered from a spinal cord injury these are common side effects then. Suffering from the irritable bowel syndrome can also cause lower back pain, not to mention a spinal tumor, a pinched nerve in the back or the Parkinsons disease.
How Can I Increase Movement Throughout The Day
Too often people think they need to attend a class at a gym for it to count as movement. Thats not true. Whether its mopping the floor, gardening, or vacuuming, its all activity. A recent study found that participating in these non-exercise physical activities was the best predictor of the UPDRS motor scores . One key to managing rigidity is to move often throughout the day.
Five simple ways to increase movement during the day
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Active Research Into Several Aspects Of Parkinsons Pain
Researchers are working to better understand the mechanisms behind pain in Parkinsons so that it can be more effectively addressed. They are looking for objective measurements, such as brain imaging, to diagnose and monitor pain, and to evaluate response to treatment. And, theyre investigating several drugs and deep brain stimulation for their potential benefits in treating Parkinsons disease pain.
Stiff Shoulder Syndrome And Parkinsons Disease
Are your shoulders stiff? You may be suffering from stiff shoulder syndrome. Could it be from Parkinsons disease?
Shoulder stiffness is, in fact, one of the conditions associated with Parkinson’s disease, a neurodegenerative disorder caused by a lack of dopamine in the brain. Dopamine is a chemical that helps you to have smooth, coordinated muscle movements.
The bones, ligaments, and tendons that make up your shoulder joint are encased in connective tissues. Frozen shoulder occurs when these tissues thicken and tighten around the shoulder joint, making it harder to move.
Nearly half of people living with Parkinson’s disease report a history of adhesive capsulitis prior to the onset of Parkinson’s symptoms. The peak incidence occurs around two years prior to the diagnosis of the disease.
The Connection Between Constipation And Lower Back Pain
So, can constipation cause lower back pain? Simply put, yes, it can. There are some connections between these issues. Constipation has been proven to cause lower back pains due to the extra accumulation of stool, but it can also lead to more severe issues and cause sciatica related symptoms more common in those who have already suffered from this affection.
Other factors may trigger the relation between constipation, lower back pain and sciatica as well. For example, being overweight is a common cause for all these things and it links everything together. At the same time, having something in the back pocket and sitting on it too often may lead to the same problem be it a wallet, a hat or your cellphone.
Now, where is the connection between all these? Simple. It is all about pressure. If you have constipation, you end up with extra stool, which means more pressure on the sciatic nerve it will naturally compress. As a direct consequence, you will end up with lower back pain and leg discomfort common issues for sciatica.
Both lower back pain and constipation are extremely common in civilized countries some of the main complaints when people see doctors. When they come together, the necessity of a medical treatment becomes even more obvious, as they might be related to more severe issues such as sciatica or even colon cancer.
What Drug Treatments Are Commonly Prescribed For Pain
Dopamine agonists are often the neurologists first weapon to alleviate Parkinsons-related pain. Levodopa is used to treat many types of pain due to Parkinsons because it treats the motor symptoms such as rigidity and dystonia that are causing them. Other medicines called analgesics can also be used to treat pain. When talking with your doctor, it is critical to let her know about all of the medications you are taking including over the counter drugs, herbs, vitamins and mineral supplements. Without complete information, your doctor may prescribe a drug that could have serious adverse effects.
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What Causes Pain In Cases Of Parkinsons Syndrome Sufferers
Parkinsons Syndrome Sufferers may present with various combinations of back, buttock and leg pain, numbness and muscle weakness, Symptoms are often aggravated by an abnormal asymmetrical gait arising from loss of spatial awareness muscle spasm and loss of limb control. The back pain may arise from irritation within the disc wall but more commonly arises from the pinching of the trapped nerve in the exit doorway from the spinal column. The foramen may be distorted and the nerve is tethered by years of scarring reaction to repetitive bruising, can not evade the pinching by the bulging distorted disc wall or overriding facet joints . The disc may be degenerate and bulging and contribute to the irritation of the tethered nerve. When advanced the compression causes numbness and weakness to develop. The patchy weakness or spasm of the muscles controlling the spinal segments results in asymmetrical loss of control or stiffness of the disc levels and aggravation of the effects of the local pathology at each level and aggravation of symptoms arising at these levels.
Lower Back Pain And Disability Assessment
After giving their informed consent, participants completed the OLBPD, which was given within 1 month preoperatively and at the 6-month and 1-year follow-up appointments to track changes in pain. The OLBPD has 10 categories , and patients are scored from 0 to 100% into categories of minimal disability , moderate disability , severe disability , crippling back pain and bedbound . Questions evaluate how the patient had been feeling over a period of time prior to answering the questionnaire with their medication and stimulator on. Participants were also asked preoperatively and 1 year postoperatively to rate their global pain on the Visual Analogue Scale of 0-10 while on medication. These scores represent how the patient was feeling right at that moment. Autonomic dysfunction was assessed at the same time points using the Scales for Outcomes in Parkinson’s Disease-Autonomic , and sleep dysfunction was assessed using the Parkinson’s Disease Sleep Scale . Depression and anxiety were assessed preoperatively and 1 year postoperatively in the patients’ standard neuropsychological evaluation using Beck’s Depression Inventory and the State-Trait Anxiety Inventory, respectively. All clinical assessments were completed with a research associate present to assist with writing, as this is often difficult in this patient population off medication. The research assistant acted as a scribe and did not influence the answers given by the patients.
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