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.
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.
Im In Pain But I Dont Want To Take Carbidopa/levodopa Yet Because My Doctor Says It Will Only Work For Five Years Any Advice
It is true that as time passes and your disease progresses, you will have to take higher doses to replace the dopamine your body can no longer produce. However, the rate of dopamine loss is different for everyone. What your doctor may be telling you is that after taking carbidopa/levodopa for some time, you may begin to experience side effects like dyskinesia. It is important to understand that while you may experience this unwanted side effect, for example, you still benefit from the carbidopa/levodopa. If you believe your pain is Parkinsons-related, and you have already tried other medications and complementary therapies without relief, it is probably time to try carbidopa/levodopa.
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Q Is There Anything Else You Would Like To Tell Our Readers
Dr. Fleisher:There are so many symptoms of PD that it can be easy to overlook pain symptoms if a patient doesnt report them. Remember that pain may be a really prominent symptom for patients, but, given that we have only learned how pain is connected to PD in the past 20 years, patients may not be aware of the association and may not bring up pain symptoms with their neurologist.
Thus, the burden is on us to ask about pain, particularly if the patient is depressed. If a patient with PD has both pain and depression, both of those comorbidities should be targeted, because it can be hard to achieve successful outcomes for either pain or depression if one is treated without the other.
What Can We Do
It would seem to me that there are a number of very vicious circles and negative feedback loops between neck stiffness/rigidity/pain and neck immobilization and posture in PD, which not only impact on each other, but also have neurological and physiological implications much more broadly, including on nervous system, blood pressure and breathing. The principal strategy for progressive symptom reduction would therefore be to increase and maintain mobilization of the neck and to improve posture as much as possible, through daily exercises and therapies, and to address any old injuries elsewhere on the body which may be impacting on posture and hence neck strain.
Dr Farias provides a suite of daily exercises which help to reduce these type of neck problems over time, especially designed for, and tailored to the different types of, cervical dystonia. Many people around the world report that doing his exercise classes daily reduces the symptoms and pain of their neck dystonia, and can eventually even lead to a full recovery. This works through a process of neuroplasticity, which re-wires the connections between the muscles and the brain through movement therapy.
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How Is Parkinson’s Disease Diagnosed
Your doctor will ask questions about your symptoms and your past health and will do a neurological examination. This examination includes questions and tests that show how well your nerves are working. For example, your doctor will watch how you move, check your muscle strength and reflexes, and check your vision.
Your doctor will also ask questions about your mood.
In some cases, your doctor may have you try a medicine. How this medicine works may help your doctor know if you have Parkinson’s disease.
There are no lab or blood tests that can help your doctor know whether you have Parkinson’s. But you may have tests to help your doctor rule out other diseases that could be causing your symptoms. For example, you might have an MRI to look for signs of a stroke or brain tumour.
Q Are There Any Alternative Therapies That Are Effective For Pain In Pd
Dr. Fleisher: Although alternative therapies may be helpful, there is little evidence-based research to support their use. Certainly massage therapy, anecdotally, seems to be helpful for managing pain. Small studies suggest that acupuncture might improve sleep in patients with PD, but data on the effects on pain in PD is lacking. Larger, more well-controlled and reproducible studies of these therapies are needed.
Patients frequently ask about the effects of medical marijuana in managing PD, including pain symptoms. Several studies have looked at efficacy of marijuana in PD and have found that it probably is ineffective for most PD symptoms.11 However, we just dont have enough evidence to know for sure. The most rigorous study of medical marijuana in PD showed a trend toward worsening tremor.11,12
For most people, stress and anxiety worsen tremor, and anything that relieves anxiety will improve tremor. Thus, modalities such as yoga, meditation, and mindfulness training will improve tremor. Similarly, medical marijuana may improve tremor in certain people by temporarily reducing anxiety and stress, but the evidence has not borne this out yet.
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.
Fourth Type Of Leg Pain Is Radicular Pain
In this case, the pain is caused by compression of nerves in lumbar area which results in weakness, numbness and tingling, and loss of reflexes from buttocks to foot in a distribution of a nerve. It can be acute or chronic, and can be worse with standing and sitting, or better with laying down. Of note: in my experience many patients including myself have these symptoms not because of physically herniated disc but rather by the stretching of a nerve in the canal as it exists due to severe musculoskeletal rigidity and abnormal posturing.
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Functional Exercise For Chronic/persistent Pain
There are some simple exercises that you can try around the house to help:
- If you experience pain in your legs, keep them strong by practising standing up and sitting down in a chair.;
- If your shoulders are aching, start by loosening them with some shoulder rolling actions, then by lifting an object that is slightly weighty from a shelf, and then replacing it. This increases the range of movement in your back, shoulders and arms, and then your strength.
Cognitive And Psychiatric Symptoms
- depression and anxiety
- mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
- dementia a group of symptoms, including more severe memory problems, personality changes,;seeing things that are not there and;believing things that are not true
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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.
My Parkinsons 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 Parkinsons disease. The doctors explain that pain is common in Parkinsons disease, often due to rigidity or dystonia, which can be exacerbated by off periods. Pain caused by Parkinsons symptoms can be relieved by Parkinsons medications, exercise, DBS and botox injections. Pain is an invisible symptom that should be mentioned to your neurologist.
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.
Q What Is The Pain Experience In Pd And Does It Differ Between Genders
Dr. Fleisher: As with almost everything else in PD, the pain experience is highly individualized, and no 2 people, regardless of gender, will have the same symptoms. Female gender appears to be an independent risk factor for chronic pain in PD, even though PD is more common in men than in women.2 Pain intensity also is higher in women than in men with PD.1
There is a lot of interesting research examining the contributions of hormones to the greater prevalence of PD in men or, conversely, the lower prevalence in women.3 Once we better understand the roles of sex hormones in the pathophysiology of PD, we may better understand whether hormones also play a role in the higher incidence of chronic pain in women with PD.
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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
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.
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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.
How To Deal With The 6 Common Causes Of Leg Pain In Pd
Severe leg pain is a common complaint from people with PD. ;Lately, it is understood that central pain is common to Parkinsons disease, and can even be the first sign of PD, usually bilaterally. ;This blog post lists six causes of lower limb pain, and the importance of treating it. ;Treatments depend on properly identifying the source of pain. ;Some treatment suggestions are included.
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What Causes Parkinsons Disease
Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.
People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.
Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.
Taking Medicine With Food
Early in the disease, it might be helpful to take pills with food to help with nausea, which may be caused by some of the medicines for Parkinson’s disease.
Later in the disease, taking the medicines at least 1 hour before meals may help them work best.
Some medicines for Parkinson’s disease don’t work as well if you take them at the same time you eat food with protein in it, such as meat or cheese. The protein can block the medicine and keep it from working as well as it should.
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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.