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.
What Is Wrong With Conventional Surgery
The use of multi-level open surgery in Parkinsons Syndrome Sufferers including microdiscectomy, decompression, solid or flexible fusion and is an overkill with negative side-effects including blood loss, potential nerve and tissue damage, extended post-operative care and unnecessarily operating on pain-free levels is fraught with aggravation of the current symptom status. It is not as effective as Foraminoplasty in addressing and ameliorating the effects of Parkinsons Syndrome Sufferers, rather it runs the risk of increased neurological complications as well as causing the complications of recurrent disc bulging, infection, nerve damage and scarring round the nerve, implant failure, major vessel damage or sexual dysfunction.
Leukemia Bone Pain Symptoms
When the bone marrow becomes overcrowded with cancer cells, the joint and bone pain kicks in. Sometimes, the leukemia cells may form a mass near the nerves of the spinal cord or the joints. With acute lymphoblastic leukemia, in particular, bone pain occurs in roughly 25 percent of patients at the onset of disease. Its less common acute myeloid leukemia.
When pain occurs, look for symptoms in the long bones of the arms and legs. You might also feel it in the ribs and sternum of the rib cage. After bone pain begins, you may also feel joint pain and swelling of large joints like the shoulders and hips. 5
Depending on the area, when asked what does leukemia pain feel like in the bone, many patients mention a sharp pain or a constant dull ache. Some may think this is due to physical activity or routine yard work. After a few days, the swelling told them otherwise.
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Medication Not Working The Way It Used To
In the early stages, taking medicine works well to get rid of symptoms. But as Parkinsons progresses, your medication works for shorter periods of time, and symptoms return more easily. Your doctor will need to change your prescription.
Dr. Valerie Rundle-Gonzalez, a Texas-based neurologist, says to pay attention to how long your medicine takes to kick in and when it stops working. She says you should feel like symptoms significantly improve or are almost gone while on medication.
When To Seek Medical Treatment
If you or your child are complaining constantly about aching bones or limping without any known injury, its important to seek help from a medical professional. When you experience pain that doesnt go away or seems to get worse over time, reach out to your doctor.
In most cases, a doctor will ask a series of questions about your bone pain. Theyll want to know when it started and where its located. Theyll also ask whether or not its getting worse and if you, or your child, have any accompanying symptoms.
In adults, remember that bone pain can often be mistaken for arthritis and in children, its easy for doctors to chalk it up to growing pains. Patients often want to know how can you test for leukemia at home, and our best advice is to familiarize yourself with the common leukemia symptoms.
If youre experiencing any of the other symptoms below, its a good idea to push for a blood test.
- Easy bruising and bleeding, including recurring nosebleeds
- Anemia
- Enlarged liver or enlarged spleen
- Pain or tenderness in the bones
- Profuse sweating, especially at night
- Petechiae, a condition that disseminates tiny red splotches on your skin
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How Is Leukemia Diagnosed
Knowing what are the early signs on leukemia can help you and your doctor catch it earlier, which can lead to a better prognosis. But after the symptoms, how is leukemia diagnosed?
A leukemia diagnosis typically happens by analyzing a patients blood sample. A bone marrow biopsy, in which a core of bone is removed with a long-needled and analyzed under microscopy, is usually also done. This helps add information about your particular type of leukemia that leads to a proper diagnosis and the right treatment options. 6
Changes In Sleeping Patterns
As Parkinsons progresses, you can also develop problems with sleep patterns. These may not happen in the early stages, but can be noticeable later. You might wake up often in the middle of the night or sleep more during the day than you do at night.
Another common sleep disturbance for people with Parkinsons is rapid eye movement sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable if someone is sharing your bed. Dr. Rundle-Gonzalez says many times a bed partner will be the one to notice sleep problems.
REM sleep behavior disorder can also happen in people who dont have Parkinsons. However, if this isnt something youve dealt with before, its likely related to your disease. There are medications your doctor can prescribe to help you sleep comfortably through the night.
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Innovative Treatment Modalities For Managing Pain In Parkinson’s
Botulinum toxin
Non-dopaminergic pharmacotherapy may benefit patients with PD-related pain. Botulinum toxin , both A and B derivatives, should be considered in patients who do not respond to dopaminergic treatment optimization.1,8 Botulinum toxin injection provides localized treatment by blocking the release of acetylcholine at the neuromuscular junction.4 Local injections of BTX type A or B can be effective for persistent dystonia-related pain and central pain, based on its neuromuscular action in movement disorders plus analgesic mechanism.
A randomized, double-blind, crossover, placebo-controlled trial concluded that BTX-A in patients with PD is safe and potentially useful in treating limb pain.29 The study was conducted in patients with PD over the age of 30 years with painful limbs not responding to the optimization of anti-Parkinsonian medications. Patients were randomized to receive BTX-A injection or placebo, followed by the other treatment per the crossover design. Depending on the location of pain, patients received up to 200 units in upper limbs or up to 300 units in lower limbs. Patients experienced a significant reduction in their self-reported numerical pain score 4 weeks after the BTX-A injection , but not with placebo . There was no difference between the change with BTX-A compared to placebo . This study demonstrated that targeted BTX-A injections are safe in patients with PD.
Cannabinoids
Opening The Medicine Box In The Mind: The Psychology Of Pain
In this 50-minute lecture, Beth Darnall, PhD explains how our experience of pain goes beyond the physical sensation of pain. It has emotional and psychological components that affect our ability to treat pain. She cites research to demonstrate that and shares 13 specific tips to reduce the experience of pain and increase treatment effectiveness. Audience questions follow the lecture.
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How Patients Feel About The Parkinsons
After coming in contact with many Parkinsons patients, we have realized that nothing can make you fall if you have the resilience and courage to fight with it. Patients describe their pain and discomfort as a frustration when they were diagnosed with this disease. A patient said that it felt as if the life completely drained out of my right arm from the elbow down” when tremors began.
Some patients added that it is correct to use Parkinsons paralysis as a term for the rigidity, unfamiliar pain and stiffness they felt in their arms and limbs muscles.
Types Of Parkinson’s Pain
Most of the time, discomfort in muscles and joints is secondary to the motor features of Parkinsons lack of spontaneous movement, rigidity, and abnormalities of posture what is known as musculoskeletal pain. The most commonly painful sites are the back, legs, and shoulders and it is usually more predominant on the side more affected by parkinsonism.
But there are many other categories of pain associated with Parkinsons disease. Radicular or neuropathic pain is experienced as a sharp pain that can start in the neck or lower back with radiation to arm or leg respectively and is often associated with numbness or tingling, or a sensation of coolness in the affected limb. It is usually secondary to a pinched nerve due to something like a slipped disc.
Dystonia related pain occurs as its name suggests, at times of dystonia most often experienced in the foot, neck or face and arm at different points in the dosing schedule, particularly the off phase when there is not enough dopamine replacement but can uncommonly also occur at peak-dose times. It can be one of the most painful symptoms those with Parkinsons can face.
Akathisia pain is experienced as restlessness, a subjective inner urge to move, an inability to stay still and the inherent feelings of discomfort that it brings. It is primarily experienced in the lower limbs and can often be relieved by walking around.
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A total of 97 Parkinsons patients at a mean age of 67.7 years, including 60 men, and 97 individuals used as controls at a mean age of 67.5 years, including six men, without the disorder or other neuromuscular diseases, filled out a questionnaire on the intensity of local lumbar back pain. The intensity of leg radicular pain caused by inflammation and/or injury to a spinal nerve root was quantified by the visual analogue scale a continuous scale used to measure pain intensity.
In addition, the participants permanent functional disability was assessed via the Oswestry Low Back Pain Disability Questionnaire a self-completed questionnaire that includes 10 different topics: intensity of pain, lifting, ability to care for oneself, ability to walk, ability to sit, sexual function, ability to stand, social life, sleep quality, and ability to travel.
Patients were further asked to describe the painful sensation they experience as pricking, tingling, burning, paresthesia often described as feelings of pins and needles, or numbness or other.
The team also assessed Parkinsons duration, medications being used, severity of motor symptoms as assessed by the Unified Parkinsons disease rating scale part III and the Hoehn and Yahr stage, which is a system used to assess symptom progression.
According to the ODI results, minimal disability was reported by 43.8% of Parkinsons patients, moderate disability by 27.5%, severe disability by 22.5%, and crippled by 6.3%.
First Type Of Leg Pain Is Central Pain
This pain is described as constant burning sensation with occasional burst of sharp pain. As it was in my case, this pain is commonly exacerbated by cold and by light touch. I could not stand the sheets to touch my skin and being in a cold room sent my pain through the roof. This type is usually bilateral but it may start on the side where other Parkinsons symptoms begin. For me, it was the leg where my rest tremor began.
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Pain Management In Patients With Parkinsons Disease: Challenges And Solutions
This review focuses on the diagnosis and management of Parkinson-related pain. It reviews the incidence and prevalence of PD, general pain and PD-related pain, the pathophysiological pathways of pain in PD, physiological pathways of pain relief, measurements of pain, clinical diagnosis of PD-related pain, and treatment strategies.
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.
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Is Accurately Targeted Treatment Possible
Single targeted surgery enables Parkinsons Syndrome Sufferers to be precisely treated with the minimum of damage to tissues, reduced patient risk and enhanced long-term outcome and more essentially without the use of General Anaesthesia. This treatment, which is called Foraminoplasty because it is carried out in the gaps or Foramen between the vertebrae, allows the nerve to thoroughly liberated and the overriding joints or pointed fracture margins to be removed. This is only possible by the use of Endoscopic Minimally Invasive Spine Surgery where the full length of the exiting nerve can be explored and the points of irritation clearly demonstrated. In the breadth of presentations arising from Degenerative Disc Disease and Failed Back Surgery or Failed Chronic Pain management, Endoscopic Lumbar Decompression & Foraminoplasty achieved a successful enduring positive outcome in 80% of cases.
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
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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.
What Are The Symptoms Of Parkinson’s Disease
Symptoms of Parkinson’s disease differ from person to person. They also change as the disease progresses. Symptoms that one person gets in the early stages of the disease, another person may not get until lateror not at all.
Symptoms most often start between the ages of 50 and 60. They develop slowly. They often go unnoticed by family, friends, and even the person who has them.
The disease causes motor symptoms and non-motor symptoms. Motor symptoms are those that have to do with how you move. The most common one is tremor.
Tremor and other motor symptoms
Tremor, or shaking, often in a hand, arm, or leg, occurs when you’re awake and sitting or standing still . It gets better when you move that body part.
- Tremor is often the first symptom that people with Parkinson’s disease or their family members notice.
- At first the tremor may appear in just one arm or leg or only on one side of the body. The tremor also may affect the chin, lips, and tongue.
- As the disease progresses, the tremor may spread to both sides of the body. But in some cases the tremor stays on just one side.
Emotional and physical stress tends to make the tremor more noticeable. Sleep, complete relaxation, and intentional movement or action usually reduce or stop the tremor.
The most common cause of non-Parkinson’s tremor is essential tremor. It’s a treatable condition that is often wrongly diagnosed as Parkinson’s.
Besides tremor, the most common symptoms include:
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