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Pain Management For Parkinson’s Disease

Painful Symptoms Of Parkinsons Disease

Mindfulness Monday – Mantra for Pain Relief with Parkinson’s Disease

Pain can sometimes be an early symptom of PD. For example, a person may complain of a painful shoulder and be diagnosed with an orthopedic condition such as a frozen shoulder, only to develop a rest tremor on that side at a later point. The painful shoulder was in fact not a frozen shoulder after all, but rather pain due to the rigidity of PD. Now of course, sometimes a frozen shoulder is really just a frozen shoulder, so theres no need to jump to conclusions when you are experiencing pain. Not every ache and pain is a sign of PD, but it is important for you to educate yourself, be aware of the possible connections, and be proactive about seeking medical attention for any notable pain you are experiencing.

If you have PD and develop pain, it is important to first bring this to the attention of your doctor. The pain may be related to your PD, or the pain may be due to a common problem such as arthritis which is exacerbated by your PD. However, in some cases, it may be a symptom of a more serious medical problem. So do not assume that the pain is related to your PD before getting an appropriate medical workup.

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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

Free Phone Consultation To See If Super 7 Testing Is Appropriate

The purpose of this free consultation is to meet or talk, and then discuss your problem. It provides you with an opportunity to determine whether you are comfortable with our approach, and whether we are comfortable with each other as people. The consultation provides an opportunity to discuss and understand your case in detail, and to determine how your health and life have been affected. We will show you a pre-consultation instructional video that will briefly explain Neuro-Biomedicine and show you our Super 7 Plus Examination process that has been ranked as the #1 most comprehensive exam patients have ever gotten. Lets stop guessing and lets find the secrets as to why youre not functioning properly with a great Super 7 Plus Examination. After meeting, we will decide if you qualify for a Step 2: Super 7 Plus Examination. All efforts are aimed at explaining adaptability, allostatic stress load, and improving function.

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Report Of Findings Qualification And Determination Of Full Plan

At Step 3: Report of Findings, if you do not qualify, you will know why, and possibly be referred to an appropriate doctor. If your case does qualify, you will be given prescription plan options. These are based on your test findings, detailed paperwork, diagnostic tests, and blood tests that were previously run. This visit is where your entire case, which has been reviewed by the doctor, is explained to you in detail. Youll learn what we found, whats wrong , and if you will respond to our treatments. Each option will be clearly explained and the features, advantages, and benefits of each plan outlined. We will show you a great video on the ROF and see all the treatments that may be required. Then you and your significant other can make smart choices and intelligent financial decisions.

These customized prescription plans are developed to address your specific root functional causes and required treatments, tests, nutrients, etc. We do not treat any medical diagnosis. We do not change any medications.

How To Deal With The 6 Common Causes Of Leg Pain In Pd

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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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Current Status Of Pain Management In Parkinsons Disease

Published online by Cambridge University Press: 13 January 2020

Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Nicole Farcy
University of Buenos Aires, Argentina
Carolina Zamorano
University of Buenos Aires, Argentina
Veronica Bruno*
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
*
Correspondent Author: Veronica Bruno, University of Calgary Foothills, Room 1007 HSC, 3330 Hospital Drive NW, Calgary, ABT2N 4N1, Canada. Email:

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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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.

Parkinson’s Pain Can Be Linked To Depression

Using Physical Medicine to Reduce Parkinson’s Disease Pain

If exercise and/or adjusting your medications do not help with the pain, ask yourself and your healthcare provider if you might be depressed. Pain in Parkinson’s disease is linked to depression, and treating the depression may help to diminish any persistent pains. Depression affects about 40% of people with Parkinson’s. In some cases, psychotherapy may alleviate pain from Parkinson’s.

If you don’t have depression or if the pains persist after treating your symptoms of depression, then you may want to consider seeing a pain specialist before taking over-the-counter remedies. Pain control specialists have a whole array of pain control treatments and techniques, ranging from special medications to special surgical procedures, that are known to be effective.

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Tips For Dealing With Chronic Pain

Chronic pain is one that last more than 3-6 months , or pain that extends behind the expected period of healing. This blog post explains the different types of pain caused by Parkinsons disease and how to address pain brought on by the disease, by medications, or by comorbid disease. It is always best to treat pain before it becomes chronic.

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.

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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.

Initiation Propagation And Maintenance Of The Pain State

How to take care of an Individual with Parkinsons Disease ...

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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Clinical Application Of The Pkg

The PKG report and can provide a healthcare professional with useful and actionable insights and should be used as an adjunct to their clinical assessment both in an in office and / or remote patient management setting. The report provides insight over a 24-hour period and provides:

  • An assessment of bradykinesia,
  • Immobility and inactivity over the 24 hours, providing insight into sleep and restlessness
  • A correlation of symptom fluctuations and their severity with respect to levodopa dosage
  • The patients self-reported levodopa compliance

The PKG report is a complementary tool for HCPs. It provides objective insight when there is uncertainty of what the patient describes and a reality of how the patient is in an ambulatory environment. The HCP and patient can make joint decisions about the type and amount of medication and obtain a longitudinal view of the patients symptoms. For the healthcare system there are efficiencies to be gained via more accurate insight at the time of consultation and via remote patient management care pathways.

Parkinsons Patients With Severe Pain Benefit From Oxycodone

In a recent paper published in The Lancet Neurology, researchers evaluated the analgesic effect of prolonged-release oxycodone-naloxone in patients with Parkinsons disease suffering from severe and chronic pain in a pioneer Phase II clinical trial. Pain is a very common, non-motory symptom in PD patients and is one of the symptoms associated with a depressed mood and reduced quality of life. Pain in PD patients has commonly only been treated by increasing the doses of dopaminergic therapy, and so far there is no full understanding on the different types of pain these patients suffer from either a medical or patient perspective.

The multi-center, double-blind randomized placebo controlled trial, funded by Mundipharma and named PANDA, included 202 patients, 93 assigned to OXN PR and 109 to placebo. The primary endpoint was set to average 24-hour pain scores at 16 weeks in the full analysis population. Although this endpoint was not significant, results were encouraging given the statistically significant differences at week 4 , week 8 and week 12 . Also, secondary endpoints revealed OXN PR treated patients used less rescue medications and had clinically relevant improvements, relative to placebo. Moreover, researchers observed an improvement in severe musculoskeletal and severe nocturnal pain compared to placebo. However, secondary adverse effects like nausea and constipation were more frequent in patients taking OXN PR than those administered with placebo.

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Who Should I See To Discuss My Parkinsons Pain

Your first point of contact should be your primary doctor. Whether that means your family doctor, neurologist, or Movement Disorder Specialist , start by asking them how to manage your pain. They may prescribe you one of the medications listed above, offer suggestions about altering your lifestyle, or refer you to a pain specialist.

Pain management specialists are physicians with specialized training in the field of evaluating, diagnosing, and treating pain so, speaking to one of these specialists might be helpful for you. Be sure to get a referral from your primary care doctor, though, to ensure you are visiting a physician who understands the complexity of treating Parkinsons-specific pain.

Health and wellness providers like physical therapists, acupuncturists, and massage therapists can also be valuable members of your care team. Be willing to try new things and approach alternative therapies with an open mind, as no ones path with Parkinsons pain is the same. What works for someone else may not work for you and vice versa. Consider visiting different specialists to find a treatment plan that works best for you.

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How Is Pain Treated For People With Parkinsons

Pain and Parkinson’s

No matter the cause, pain is often complex. When a person with Parkinsons experiences intense pain, especially in combination with other symptoms of Parkinsons, managing it can be challenging. There are, however, several ways you can adjust your medication regimen, exercise schedule, and lifestyle to reduce your pain and improve your quality of life.

Medications

There are various kinds of medications used to treat pain, especially for people with Parkinsons. In a recent webinar, Dr. Janis Miyasaki described how physicians approach pharmacological treatment of pain for people with Parkinsons:

The principle is to start with what is called the pain ladder. You always start with the least intensive, least side effect-giving treatment.Janis Miyasaki, MD

Step one

The first step of the pain ladder is hot and cold treatments along with stretching and flexibility exercises. People who experience rigidity and stiffness can sometimes alleviate pain using heating pads to loosen their muscles, then improve mobility by stretching, then address any residual pain with ice packs.

Step two
Step three
Step four
Step five
Other medical interventions

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How Is Pain Diagnosed Assessed And Treated

Diagnosing and treating pain in people with Parkinsons can be difficult and often, common ways of reducing pain, such taking painkillers or doing regular, gentle exercise may not help.

Usually, your doctor or Parkinsons nurse specialist will be able to help you to manage the more common types of pain, such as shoulder pain and headaches. Certain other types of pain, however, such as pain caused by involuntary movements or burning mouth, may need the help of your Parkinsons specialist.

Completing a Kings Parkinsons Disease Pain Questionnaire and showing it to your heath-care professional will help them to understand the pain you are suffering from1. Completing the 24-hour Hauser2 diary, a home diary designed to assess your motor symptoms, over the same period of time, would further help your doctor or Parkinsons nurse to better understand the pain you are experiencing and to treat it more quickly.

To ensure Parkinsons pain is assessed and diagnosed efficiently, a specific scale has been designed. Kings Parkinsons Pain Scale 1 is a validated scale which covers the common types of Parkinsons related pain. Your Parkinsons specialist might use this scale to help understand the type of Parkinsons pain you have even better and assess what needs to be done to help you further.

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Super 7 Plus Examination Package

Yes, after the phone consult Ill know if I qualify for Step 2 and Step 3.

The cost for Step 2/Step 3 is $1,299. If after the phone consult the doctor thinks I qualify, and I agree to move forward with Step 2/Step 3, my payment of $1,299 is due so that I can then reserve and schedule my Step 2/Step 3 appointments. The best part of this offer is that Im protected by your Better than risk free, iron-clad guarantee, which states:

If you are not 100% satisfied that our Step 2: Super 7 Plus Examination Package and Step 3: Report of Findings / Prescription Plans are not the MOST COMPREHENSIVE EXPLANATION AND TESTINGTHAT IT PROVIDED REAL, VALUABLE INFORMATION FOR YOUR CASE, then Ill give you a 100% REFUNDNO QUESTIONS ASKED

Before the examination begins, you will watch an instructional video on the brain which explains why were doing the exam. You will also re-watch the Super 7 Plus examination videos. These instructional videos lay the foundation for you to learn, understand, make good decisions, and if you qualify, provide care options. Then a full record review is undertaken to look at all Neuro-Immune Endocrine parameters.

Reasons for Not Qualifying:

  • A serious medical disease/diagnosis emergency that is outside of my scope of practice.
  • Your test results and ability to respond and improve from our prescription treatment plan.
  • Our ability to work together as a team and your commitment to do your part in the healing process.
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