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.
Physical Therapy
Alternative treatments
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 Is A Common But Overlooked Problem In Parkinsons Disease
Pain is an often overlooked non-motor symptom of Parkinsons disease . Studies show that between 40-80% of people with PD report pain, which is likely why it is often suggested as a topic for this blog.
One of the reasons why the topic of pain and PD is difficult to address is that it is sometimes tough to discern whether a particular pain is due to PD or not. Chronic pain is such a common symptom among the general population, and people with PD are not immune to common problems as well. However, there are aspects of PD that may exacerbate the pain experienced from a common problem. In addition, there are particular types of pain that may be unique to people with PD.
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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Who Develops Parkinson’s Disease
PD mainly develops in people over the age of 50. It becomes more common with increasing age. About 5 in 1,000 people in their 60s and about 40 in 1,000 people in their 80s have PD. It affects men and women but is a little more common in men. Rarely, it develops in people under the age of 50.
PD is not usually inherited and it can affect anyone. However, one type of PD, which appears in the small number of people who develop it before the age of 50, may be linked to inherited factors. Several family members may be affected.
Management Of Pain In Parkinsons Disease
Issue title: Special Issue: Clinical management of Parkinsons disease: Essentials and new developments
Guest editors: Bastiaan R. Bloem and Patrik Brundin
Article type: Review Article
Authors: Buhmann, Carstena; * | Kassubek, Janb | Jost, Wolfgang H.c
Affiliations: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | Department of Neurology, University of Ulm, Ulm, Germany | Parkinson-Klinik Ortenau, Wolfach, Germany
Correspondence: Correspondence to: Prof. Dr. Carsten Buhmann, Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 52771; Fax: +49 40 7410 45780; E-mail: .
Keywords: Parkinsons disease, pain, therapy, analgetics, pathophysiology, non-motor symptoms
DOI: 10.3233/JPD-202069
Journal: Journal of Parkinson’s Disease, vol. 10, no. s1, pp. S37-S48, 2020
Abstract
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Why Pain Occurs In Parkinsons Disease
Parkinsons is a brain disease that is caused by the death of cells responsible for dopamine production. Dopamine is a chemical messenger that plays an important role in body movement. It is mainly concentrated in the substantia nigra part of the brain. When its production ceased in the brain, the body experience abnormal movement .
In addition to the substantia nigra, dopamine can also be found in other regions of the brain like thalamus, basal ganglia, insula, and anterior cingulate cortex. These regions are typically associated with pain perception. The presence of dopamine in these areas suggests that, in addition to its main role in the movement, dopamine may also involve in the modulation of pain sensation within the brain .
In fact, recent research shows that a low level of dopamine in some of these regions contribute to develop pain in the body. This evidence strongly suggests that apart from motor symptoms, a low level of dopamine also causes pain. And this could be the likely reason why people with Parkinsons feel pain in their body .
But most clinicians think that Parkinsons disease symptoms are the actual cause of pain. The pain is directly linked to the intensity of symptoms, the more strong the symptom the more pain will be felt .
For example, rigidity is one of the major symptoms;in Parkinsons patients. Those patients who have high rigidity are tended to experience more pain than those who have less.
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.
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Pain Shows Up As Parkinson’s Sets In
Study Shows Pain Is Felt at Onset of Parkinson’s Disease
New research shows that another thing to look for as Parkinson’s takes hold is pain.
The study, led by Giovanni Defazio, MD, of the University of Bari, shows that people with Parkinson’s have more pain than those who are disease-free.
Researchers found that the pain seems to show up with the onset of the disease or shortly thereafter.
The research team looked at 402 patients who had Parkinson’s disease, comparing them to 317 people who did not have the disorder.
The groups were similar in ages and the proportion of men and women.
However, more Parkinson’s participants had depression and medical conditions associated with pain symptoms, such as diabetes and herniated discs.
Taking into account age, sex, depression, and other medical conditions associated with pain, 70% of the Parkinson’s patients said they experienced pain lasting at least three months, compared with 63% of the comparison group.
The type of pain that the Parkinson’s patients most reported was related to “dystonia” — involuntary muscle contractions.
Among the Parkinson’s patients, 17% had dystonia. Dystonic pain was more commonly located in the leg, foot, neck, or shoulders.
When it came to pain that was nondystonic, rates were similar between Parkinson patients and the comparison group.
The average age for the onset of Parkinson’s disease was 60.
General Aspects Of Pain Treatment In Pd
Despite the high prevalence of pain in PD, literature data suggest that only up to a maximum of 50% of PD patients receive at least some type of pain therapy .
Still, the fundament of pain therapy should be an optimized dopaminergic treatment which can improve pain related to insufficient dopaminergic supply such as akinesia and/or rigidity , pain due to dopaminergic over-supply such as dyskinesia and/or dystonia , or central pain that is dopamine-sensitive . This concept was reported to be effective in about 30% of PD patients . A standardized levodopa test can be helpful to decide whether the pain is dopaminergic responsive or not, but any result of this short-term effect must always be interpreted with caution so that the long-term assessment of pain under dopaminergic therapy over several weeks remains essential .
A systematic review and meta-analysis including databases from January 2014 until February 2018 investigated the efficacy of a variety of novel, complimentary, and conventional treatments for pain in PD and found the greatest reduction in pain for safinamide, followed by cannabinoids and opioids, multidisciplinary team care, COMT-inhibitors, and electrical and Chinese therapies, while the weakest effects were obtained for dopaminergic agonists and miscellaneous therapies . Table;1 gives an overview of larger randomized controlled trials of antiparkinsonian drugs and opioids assessing the effect on pain in PD patients.
Table;1
Fig.1
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What Causes Parkinson’s Disease
PD is a disorder of the nervous system. A small part of the brain, called the substantia nigra, is mainly affected. This area of the brain sends messages down nerves in the spinal cord to help control the muscles of the body. Messages are passed between brain cells, nerves and muscles by chemicals called neurotransmitters. The brain cells in the substantia nigra produce dopamine, the main neurotransmitter.
If you have PD, a number of cells in the substantia nigra become damaged and die. The exact cause of this is not known. Over time, more and more cells become damaged and die. As cells are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain causes nerve messages to the muscles to become slowed and abnormal.
Pain In Pd: Assessment And Classification
In order that novel and optimal pharmacotherapeutic targets may be identified, a deeper understanding of the pain circuitry in PD patients who experience persistent pain is required. Since we know that unique maladaptive changes occur in central modulatory pathways that govern pain and neurodegeneration, identifying pathophysiological hallmarks for persistent pain and Parkinsons disease states, likely highly plastic and stage specific, is crucial.
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Q Are There Any Gender Disparities In The Treatment Of Pain In Pd
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.
Initiation Propagation And Maintenance Of The Pain State
While we do not know the underlying mechanisms that drive PD singular, persistent pain singular, nor persistent pain in PD, bench and bedside research investigative efforts have partially defined some of the factors important in the initiation, propagation and maintenance of each. Continued forward and back translational preclinical and clinical research will provide comprehensive disease pathology insight and guide towards a mechanism based therapeutic approach to facilitate analgesic target identification. Psychophysical testing in humans, with its promise to link animal and clinical pain studies, is essential to fully understand the mechanisms that contribute to the development of persistent pain.
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Pain In Pd: Current Treatment
Pain is a multi-dimensional experience involving sensory discriminative and affective motivational descriptive axes. As such, pain perception is inherently subjective and influenced by multiple factors. While acute pain reflects an adaptive survival mechanism, persistent pain negatively impacts the quality of life of the affected individual and serves limited evolutionarily advantage. Unfortunately a large proportion of people with PD experience persistent pain and 50% of those individuals receive no or inadequate treatment,. Therapeutic strategies that offer an improved analgesic profile remain an unmet clinical need. Clearly multi-disciplinary approaches for pain management that encompass new concepts in pathogenesis and treatment are required,.
Pain In Parkinsons Disease: A Spotlight On Women
This 2-page interview with neurologist, Dr. Jori E. Fleisher, discusses pain in Parkinsons disease with some interesting statistics about women and pain. ;Dr. Fleisher outlines the 4 primary types of pain in PD, how depression interferes with pain management, the role of exercise and medications in pain management as well as alternative therapies.
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Can The Sources Of Pain Be Pinpointed
Aware state surgical examination enables the patient to give the surgeon feedback, guiding him or her to the point that is responsible for the pain. This live approach allows the causal level in Parkinsons Syndrome Sufferers to be accurately defined and then viewed using endoscopic instruments through a tiny incision. In this way, neural anomalies and strange nerve combinations can be detected and diagnostic errors regarding the disc level responsible for the pain, avoided. Thus, the surgeon is guided to the precise source of pain at that specified inter-vertebral point and the understanding of the actual mechanisms underlying the causation of Parkinsons Syndrome Sufferers.
What Can I Do On A Regular Basis To Manage My Pain
Remember, youre your best advocate as you understands how your pain feels. Understanding and communicating the kind of pain youre experiencing can greatly inform your treatment plan and will allow your doctors to address the type and severity of your specific pain. Keep your care team informed about activities that cause pain or the times of day your pain is worst so they can help fine-tune your care plan. Do you notice the pain starting to creep in at a certain point after you take your medication? Do you feel fine when you bike but experience pain when you jog? Did you start experiencing this pain before or after your Parkinsons diagnosis? Taking stock of these sorts of questions can be helpful as you work with your care team to effectively treat your pain.
Incorporating approved medications and following the pain ladder can also help you find the right pain management solution, as can taking steps in your everyday life to be an active participant in your own pain management. Regular stretching, heat and cold treatments, exercise, yoga, and dance can all help reduce your pain, and they are all steps that you can take on your own. Making adjustments to your home and workspace, such as minimizing places where fall risks are likely, using an ergonomically designed desk, sleeping in a comfortable bed, and wearing clothes and shoes that dont exacerbate pain, can help you establish a more pain-free daily routine.
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How Is Pain Treated In Patients With Parkinson Disease
Pain serves as 1 of the most frequent nonmotor complaints in patients with Parkinson disease , affecting 68% to 95% of patients across all clinical stages. Published in the Journal of Parkinson Disease, researchers highlight that similar to PD, pain is complex and even has different classifications of subtypes within the disease.
While prominent, real-life pain data in PD remains scarce. Researchers sought to provide an overview on pain in PD, including classification, assessment, presentation, and the existing therapy landscape.
As researchers highlighted, todays classifications of pain in PD include musculoskeletal, radicular/neuropathic, dystonia-related, akathic discomfort/pain, and central pain. Notably, the difference in pain directly related to PD and central pain, which is attributed to objective painprocessing and pain-perception disturbance within ascending and descending pathways, was referenced. Most frequently, pain presents as musculoskeletal/nociceptive pain in PD patients, but in nearly half of the PD population, comorbid conditions, such as spine and joint arthrosis, serve as contributors.
When it comes to treating pain in PD, interventions remain a major unmet need as only approximately 50% of those with the disease receive at least some type of pain therapy. In managing pain, researchers recommend that therapy should be optimized to address dopaminergic issues, which has been shown to be effective in 30% of patients with PD.
Reference
The Benefits And Research Around Cbd Are Still Emerging
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. She is an associate professor of neurology at Tufts Medical School and medical director of the Lahey Clinic Multiple Sclerosis Center in Lexington, Massachusetts.
With the legalization of medical marijuana, many states are approving the use of it in a non-traditional way to treat the symptoms of certain conditions, including Parkinsons disease. Marijuana has two major components to ittetrahydrocannabinol and cannabidiol . Both may help with nausea and muscle pain or spasms, but unlike THC, CBD doesnt give you the high feeling marijuana is most commonly known for. This makes it an enticing, natural way for many to help treat their Parkinsons disease symptoms. Whats more, is that because CBD is a natural compound from the Cannabis sativa plant, using it may also leave you side effect-free, unlike many prescription medications.
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Pain The Key But Undermined Symptom Of Parkinsons
Although undermined for many years, pain is now being considered as one of the key symptoms in Parkinsons disease. Like other typical symptoms, pain can also bother patients daily life and sometime it could be so intense that it overshadows other key signs of the disease .
During the course of the disease, the painful sensation feels by the patient but it doesnt get enough attention from caregiver and family members. Unfortunately, it is also sometimes underestimated by neurologists. Thiss why this sign of the disease is overlooked and remains untreated. If youre one of those patients, you may know this fact very well .
Pain in Parkinsons disease can vary from person to person. In some patients, the pain sensation is very mild and may feel like aching, which is usually neglected most of the time. In others, the pain is pretty sharp and sometimes its so extreme that it can dominate over motor symptoms.
Usually, the pain intensity is higher in the morning or late at night. During this time of the day, the whole body feels rigid and any movement can prompt pain in the body.