Wednesday, December 7, 2022
Wednesday, December 7, 2022
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Does Parkinson’s Disease Cause Pain

Make Commercial Breaks Movement Breaks

Pain and Fatigue in Parkinson Disease – 2019 Parkinson Educational Symposium

If youre watching TV, stand up and march while you swing your arms during the commercials. To increase your muscular strength, lift soup cans or a do a few downward dogs.

Moving more every day is easier said than done. Remember, even small changes can make a big difference. Pat yourself on the back for all of the movement activities you do each day. Every victory counts!

Pathophysiological Pathways Of Pain In Pd

The origin of pain in PD remains poorly understood. At times, it appears as dystonia when the dopaminergic effects wear off. The pathophysiological mechanisms behind this phenomenon are most probable by which dopamine, in the network with other monoamines such as noradrenaline and 5-hydroxytryptamine , interacts through inhibitory and excitatory pathways. Abnormalities in descending pathways affect central pain processing. In addition, clinically registered neuropathic pain and other muscular pain sensations are described by PD patients. This has led to the exploration of pathways other than those secondary to rigidity, tremor, or any other motor manifestations of the disease, with abnormal nociception processing in PD patients suffering from pain as the most likely suspect. The basal ganglia process somatosensory information in different ways, and increased subjective pain sensitivity with lower electrical and heat pain thresholds has been reported in PD patients. This abnormal processing also comprises PD-related disorders such as multiple system atrophy, which exhibits almost the same prevalence of pain as PD.

The pathophysiological basis of sensory disturbances in PD, the so-called pain matrix with information from different loci, processed in the BG.

Abbreviations: PD, Parkinsons disease BG, basal ganglia GPe, globus pallidus externa, GPi, globus pallidus interna STN, subthalamic nucleus.

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.

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What Are The Different Stages Of Parkinsons Disease

Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

Early stage

Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

Mid stage

Mid-late stage

Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

Advanced stage

James* Was Diagnosed With Parkinson’s In 2011 His Pain Has Worsened As His Condition Has Progressed

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When I was diagnosed with Parkinson’s, I initially felt little to no pain. It’s only now, in the advanced stages of the condition, that I’ve started feeling pain, coupled with the normal ageing process.

One of the worst pains I experience is dystonia and dyskinesia of the upper body, especially in my neck and head. It usually starts with a pulsing headache, followed by jerking of the muscles in my face, neck, upper torso and hands. It’s particularly severe in my arthritic finger and my neck. It can be severe to mild, often very distressing, and can last up to 2 hours.

I also have mild to moderate, uncontrollable movements or swaying associated with dyskinesia. It’s more prominent when I’m sitting down at a table or working on my laptop. Strangely, I feel this pain at its worst when I’m on the phone, or trying to explain something, or if I’m feeling over-excited or anxious which is when I become severely dyskinetic. There’s now a dull, continuous pain in my neck, caused through the movement, which gets sharper during bouts of the symptom.

I also experience pain when standing, mostly during a ‘wearing off’ period. My knees pull towards each other and the pain is so severe that I can’t walk. Luckily it only lasts a minute or 2, but the pain can be distressing.

To ease the pain, I take paracetamol as and when, occasionally co-codamol, and very occasionally an anti-inflammatory, for the arthritis. I previously tried cannabis oil but it was of no benefit to me.

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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.

A Bottle Neck To Neurological Health

I have noticed that a lot of people with Parkinsons Disease, and other neurological disorders too, such as Alzheimers, suffer with severe neck pain and/or stiff, rigid necks. In terms of neurological problems, our necks can be a pinch point – a constricted passageway or tunnel, through which all the superhighways between our brain and the rest of our nervous system and organs, and from there, out into the far reaches of our fingers and toes, must pass. All of our utilities, the two-way electrical wirings, the broadband and telegraph wires of the nervous system, the water and air supplies, the chemical pipelines providing nutrients and the sewer pipes taking away the excreta of the brain, must pass through this narrow gap. This is no ordinary tunnel: to keep these utility supplies open and running, it was designed to keep on moving itself and in truly extraordinary ways of flexible motions.

Even slight damage or stiffening up of the neck can cause constrictions or interruptions of these important electrical and chemical flows. For oxygen and nutrients that enter through the mouth or nose, it is double jeopardy, as they have to pass through the bottle-neck twice, down into the lungs or to the gut, and back up again to get the brain. The neck is therefore a primary attention site for progressive symptom reduction strategies. In this article, we look at aspects of the neck and consider what we can do to improve our lot.

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Pain Due To Fluctuations Dyskinesia Or Dystonia

To reduce potentially pain provoking motor fluctuations and dyskinesias, the optimization of therapy aiming to smoothen dopaminergic plasma level is recommended. The use of prolonged acting dopamine agonists or substances reducing the dopamine degradation such as MAO-B or COMT inhibitors are thought to reduce painful motor fluctuations during day- and night-time as well as early-morning akinesia. PD patients with motor fluctuations, who received the finally not approved partial dopamine D2 agonist Pardoprunox as adjunct therapy to levodopa, showed in a post-hoc analysis of a RCT a greater decrease in VAS pain scores compared to placebo . Amantadine might be helpful for painful dyskinesia, but data is missing.

A second substance with a potential specific effect on pain might be safinamide. In a post-hoc analysis based on pooled data of two large RCTs, safinamide applied as add-on therapy to levodopa treatment was associated with less consumption of pain medication compared to placebo and a significant reduction of pain in two of three sub-items of the PDQ-39 scale reflecting musculoskeletal and neuropathic pain . Noteworthy, in the safinamide group a slightly higher percentage of patients had additional pain medication at study baseline. In summary, this limited benefit needs to be confirmed by dedicated future studies.

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My Parkinsons Story: Pain

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%.

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Is Parkinsons Disease Inherited

Scientists have discovered gene mutations that are associated with Parkinsons disease.

There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.

Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.

Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.

Examples Of Pain Scales In Pd

Pain-O-Meter

This is a self-administered pain assessment tool developed for the purpose of improving pain assessment and management in acute and chronic pain patients, not exclusively for PD pain. It is a hard, white, plastic tool. Two methods for assessing pain are located on the Pain-O-Meter . The first is a 10-cm VAS with a moveable marker that patients use to rate their pain. The second is a list of 15 sensory and eleven affective WDSs. Each WDS is assigned an intensity value that can be as low as 1 or as high as 5 .

Durationa of disease, 5 years/> 5 years Pain before/after PD diagnosis Durationb of pain/day, 10 h/> 10 h VAS,c5 cm/> 5 cm Pain expressions by participants

Notes: POM results for PD and chronic pain patients. Data from Skogar et al.

P

Abbreviations: PD, Parkinsons disease h, hours VAS, visual analog scale RLS, restless legs syndrome POM, Pain-O-Meter.

Kings PD Pain Scale

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Lower Back Pain In People With Parkinsons

In a previous blog, we discussed pain and PD in general and highlighted different types of pain that a person with PD might experience.

PD contributes factors that can cause or worsen lower back pain, such as rigidity of the trunk muscles or dystonia of the trunk muscles. Both rigidity and dystonia can fluctuate with medication timing and correlate with ON and OFF time.

In addition, PD can be associated with central pain, which is poorly understood and thought to be due to abnormalities in the brain itself. Some new research suggests that PD can change how the brain feels pain that the loss of dopamine can make pain feel worse or make a person more likely to feel pain.

We know that:

  • there is a higher prevalence of lower back pain in people with PD vs aged-matched controls
  • certain features of PD such as increased age, depression, rigidity, and stooped posture are associated with lower back pain
  • lower back pain can make it harder to deal with the challenges of PD because it is associated with lower activity levels. This can breed a vicious cycle in which lower back pain leads to decreased activity levels and then lower activity levels conspire to make the lower back pain worse

Q Are There Any Gender Disparities In The Treatment Of Pain In Pd

Parkinson

Dr. Fleisher: I dont think there is any literature demonstrating gender disparities in pain treatment among patients with PD, but we do know that there are certainly gender disparities overall in the treatment of women with PD, so it would not be surprising to learn that women with PD-related pain are at a disadvantage and not getting the appropriate care that they need.

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Pain Management Principles In Parkinson’s Disease

Non-pharmacologic methods with a multidisciplinary pain team should be utilized to provide optimal multimodal treatment in patients with PD.4 Muscle relaxation exercises and walking regularly can improve flexibility and dampen experiences of pain associated with motor symptoms.6 Rehabilitation with a physical therapist can improve gait and balance, targeting pain caused by motor symptoms. Surgical interventions, such as deep brain stimulation or an implanted spinal cord stimulator, may be appropriate for those patients experiencing pain with PD who do not respond to pharmacologic or rehabilitation interventions.1,6,9

Optimization of treatment with levodopa and other antiparkinsonian medications should be the first pharmacological step in managing PD-related pain.6,8 Beyond this recommendation, no evidence encourages the use of specific analgesic agents in any stepwise order, making patient input and assessment of pain type critical to appropriate treatment.

Patients should be prescribed analgesics if optimization of dopaminergic agents is not effective on its own .4

Optimization of Dopaminergic Agents

Safinamide is a selective, reversible MAO-B inhibitor that reduces degradation and reuptake of dopamine to increase levels in the striatum.19 Safinamide also has non-dopaminergic properties that modulate glutamate release via inhibition of voltage-gated sodium channels. This dual mechanism may mitigate pain, especially during off periods.

Lower Back Pain And Parkinsons Disease

Lower back pain is an extremely common problem in the general population, as well as for people with Parkinsons disease . It tends to make moving more difficult, adding to the challenges of PD. Tim Nordahl, PT, DPT, a physical therapist at Boston University gave an excellent presentation as part of APDAs Lets Keep Moving Webinar Series. Because this is such a prevalent issue, and because there are things you can do to help alleviate your back pain, I wanted to summarize and highlight this important topic.

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Join The Parkinsons Forums: An Online Community For People With Parkinsons Disease And Their Caregivers

Chronic pain between the two groups was assessed using the Brief Pain Inventory , which measures pain severity , pain interference and pain frequency. A qualitative description of pain was also conducted.

Patients described pain as exhausting,tiring,penetrating,miserable and unbearable significantly more often than controls.

Among patients, those with depressive symptoms as evidenced by a score of eight or higher in the Hospital Anxiety and Depression Scale reported pain as tender more frequently than those without depression. Controls with depressive symptoms were more likely to report pain as stabbing, tender and tiring compared to those without evidence of depression.

These descriptions indicate a significant impact of pain on the psychological well-being of the patient, the researchers wrote.

Subsequent analysis showed that patients overall scored higher than controls in worst pain felt since last week and in global pain severity. Among all participants with depressive symptoms, those with Parkinsons had higher scores of worst pain felt and average pain felt since last week, as well as higher reported pain levels at the time of assessment and global pain severity than those in the control group.

Symptoms of depression led to similar differences plus an additional higher impact on social relations between patients and controls. Of note, depression was associated with greater difficulties in walking in the group without Parkinsons.

Can Parkinsons Disease Be Prevented

Ask the MD: Pain and Parkinson’s

Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.

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