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Dystonia And Pain Management For Parkinson’s
Movement disorder specialist Alfonso Fasano, MD, PhD, outlines how to tease apart whether pain is a symptom of PD or due to an orthopedic issue. He explains how to approach the treatment of pain in concert with your medical team, going over several treatment options. Finally, Dr. Fasano focuses on causes of and treatments for dystonia and dyskinesias. After a 40-minute talk he spends 30 minutes answering questions.
Increased Urination Urgency And Frequency
Bladder problems are a common occurrence in people with Parkinsons, occurring in 30-40 percent of people with the disease. The most common urinary symptom is a frequent and urgent need to urinate even when the bladder is empty, as well as trouble delaying urination.
Trouble emptying the bladder is a less common feature of Parkinsons urinary dysfunction. It may be caused by difficulty in relaxing the urethral sphincter muscles that allow the bladder to empty.
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When To Call Your Doctor
You should contact your doctor if your foot and leg cramps are severe and occur frequently.21Other reasons for calling your doctor about muscle cramping include muscle weakness and atrophy and the inability to sleep because of nighttime cramps. Alcoholics who experience foot and leg cramping should seek medical care.
Although foot cramping can be a briefly painful annoyance, it is usually not serious. Take good care of your body, and you will experience less incidence of foot cramps.
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 Can A Chiropodist Podiatrist Or Physiotherapist Help People With Parkinsons Look After Their Feet
If you have problems with your feet, you can visit a podiatrist or a chiropodist for advice there is no difference between them.
Podiatrists look at all areas of foot care, including how the foot should work during normal walking and the problems caused by not walking in a typical pattern.
Your podiatrist can train you to stretch and exercise your muscles to reduce the effects of stiffness or rigidity on your feet. They can also show you simple massage techniques to improve your movement and circulation.
Physiotherapists can also help you. They often work with podiatrists on foot-related mobility problems and to help prevent falls.
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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What Can Be Done To Help Muscle Cramps
Some cramps may respond to vigorous massage and the application of a heat pad or hot water bottle. Simply moving around may also help, or a physiotherapist can advise you on a number of stretching exercises that may help relieve the stiffness and soreness . If these treatments are not effective, the cramping may respond to drugs such as quinine or muscle relaxants . You should discuss this option with your doctor. For further information, see the Parkinsons Associations Information Sheet on Pain in Parkinsons Disease
Acpa And Stanford Resource Guide To Chronic Pain Management
This 213-page downloadable PDF is a comprehensive, integrated guide to medical, interventional, psychological/behavioral, pharmacologic, rehabilitative, complementary and integrative, and self-help strategies in the treatment of chronic pain. It covers general information compiled from multiple sources, is updated yearly and includes imbedded web links for certain medications and treatments and relevant internet sites of interest.
This questionnaire can help identify type of pain and determine whether someone should see a pain specialist.
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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.
What Causes Numbness And Tingling In The Arms And Legs
Diabetic neuropathy is a nerve condition of the extremities causing numbness, tingling, and pain. Wernickes encephalopathy can cause confusion, lack of muscle coordination, and vision problems. Cold exposure symptoms include color changes on the skin, numbness, stinging, redness, blisters, and more.
There is no need for treatment other than patience. Its worthwhile to note that carpal tunnel syndrome can also cause numbness in the middle fingertip . However, there will be other symptoms with carpal tunnel syndrome.
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How Can I Treat Episodes Of Dystonia
You first need to determine the cause of your muscle pain and make sure it is not cramps.Secondly, you must determine when dystonia occurs in regard to your levodopa dose intakes. The best way to do this is by keeping a diary for a few days. You will then be able to explain this phenomenon in full detail to your neurologist, who will be able to optimize your treatment with you.
Many people with episodes of dystonia reduce the intensity of their pain by:
- Gently touching the affected body part with their finger or with other objects of different textures
- Touching a part of the body close to the part affected by the contraction
- Stretching the part of the body affected by the contraction
Relaxation techniques can also help relax muscles affected by dystonia.
Stages Of Parkinsons Symptoms
Parkinsons symptoms can be divided into three categories or phases: pre-motor, motor, and cognitive. These phases dont necessarily happen in chronological order, and not all Parkinsons patients will experience all symptoms.
The premotor phase is the phase of Parkinsons in which non-motor symptoms are present. These symptoms include:
- loss of smell
There are two main categories of tremor: resting tremor, and action tremor. Resting tremor occurs when muscles are relaxed, like when your hands are sitting in your lap, and lessen during sleep or when the body part is in use. Action tremors occur with the voluntary movements of a muscle.
Tremors typically affect only one side of the body but may affect both sides as the disease progresses. Fatigue, stress, and intense emotion may worsen tremors.
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How Might Dystonia Be Experienced
- Feet: people with Parkinsons mainly experience dystonia in their feet. Typically the toes curl up into a claw-like position, the foot turns inwards at the ankle, and occasionally the big toe sticks up. This position, caused by spasms in the calf muscles, can be very uncomfortable and makes it hard to fit feet into tight shoes.
- Hands: writers cramp in the hands only occurs during handwriting.
- Neck: cervical dystonia affects the neck muscles, which causes the head to twist to one side, forwards or occasionally backwards.
- Eyelids: the eyelid muscles may contract and make the eye close involuntarily . This is often experienced as excessive blinking, intolerance to light, a burning feeling in the eye or irritation.
- Vocal cords: dystonia affecting the vocal cords or speech muscles makes speaking difficult or strained.
- Jaw area and side of the face:oromandibular dystonia affects the jaw area, tongue, mouth or one side of the face. The jaw may be pulled either open or shut, and speech and swallowing can be difficult.
Treatment For Dystonia In Parkinsons Disease
The exact relationship between PD and dystonia remains unknown, which makes treatment challenging. The Parkinsons Foundation recommends tracking when dystonia symptoms occur in relation to taking levodopa, the most commonly prescribed medication for PD. If dystonia occurs when levodopa levels are low, such as upon waking in the morning, then your doctor may recommend adjusting the timing or dosage of your medication.
If dystonia occurs even when levodopa has achieved peak levels in your body, then your doctor may recommend injections of botulinum toxin to the affected muscles. Botulinum toxin relaxes muscles and makes it difficult for them to contract, even involuntarily. The injections are repeated every few weeks.
Deep brain stimulation also has shown promise for relieving dystonia in Parkinsons disease . However, sometimes DBS can trigger a dystonia, such as eyelid twitching, so this treatment usually is reserved as a last resort.
As a symptom of Parkinsons disease, dystonia can inhibit you from pursuing physical activities you enjoy. But exercise and physical activity are powerful tools in managing PD. Work with your doctor to find medications that improve dystonia symptoms and keep you as mobile as possible. Staying active can help you maintain a high quality of life when living with PD.
Memory Or Thinking Problems
Having issues with thinking and processing things could mean your disease is progressing. Parkinsons is more than a movement disorder. The disease has a cognitive part as well, which means it can cause changes in the way your brain works.
During the final stage of the disease, some people may develop dementia or have hallucinations. However, hallucinations can also be a side effect of certain medications.
If you or your loved ones notice that youre getting unusually forgetful or easily confused, it might be a sign of advanced-stage Parkinsons.
Managing Pain In Parkinson’s
This article summarizes the incidence, types, and causes of reported pain in Parkinson’s Disease . A table of recommendations on how to involve patients with Parkinson’s in their own pain management is provided, along with approaches to pain assessment. Finally, there is a discussion of pain management principles in PD, including optimization of dopaminergic medications, use of analgesics, and innovative treatments for pain management .
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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.
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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 Is An Unfortunately Common Problem In Parkinsons Disease
Of course, pain is common in the general population, especially among older people. A recent American study found that pain affected about twice as many people with Parkinsons Disease than those of the same age and gender without PD. About 50% of Parkinsons Disease patients in that study suffered from painful disorders. Men and women seem to be about equally affected. A very well described scenario is the patient who is followed for a painful frozen shoulder for a year or so before a tremor develops leading to a diagnosis of PD. Pain clearly plays a major role in quality of life. Everyone with chronic pain enjoys life less, leading to a vicious cycle in which pain causes depression or isolation which in turn leads to more pain.
Parkinson patients suffer from the same pain problems that other people have, often amplified by the motor dysfunction, but they also have additional pain problems which are unique to PD.
One recent review classified the types of pain Parkinsons Disease patients have into: musculoskeletal, in which the pain results from problems with the muscles , bones or joints dystonic, which is due to abnormal muscle contractions caused by the Parkinsons Disease or the medications used to treat it radicular pain, which is feels like the pain caused by pinched nerves central pain, which is presumed due to abnormalities in the brain, and is a continuously present pain that cannot be explained otherwise and discomfort related to an unpleasant urge to move.
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Foot Cramps While Sleeping
Some people experience foot cramping only at nighttime, often when theyre sleeping. Why does this happen only at this one time of day? Well, most medical professionals believe its because youve finally stopped for the day and your body is finally catching up with you. Especially in the form of muscle fatigue.
For example, if youve been standing all day, especially on hard floors, when you finally lay down and relax your feet start to cramp. Likewise, not drinking enough water or getting enough electrolytes from the food you eat can come back to haunt you when you finally lay down to rest.17
The pressures of pregnancy on the body, or the fact that the foot is passively pointed while youre sleeping, have also been illuminated as potential causes of nighttime foot cramping. While medication-induced cramping also seems to hit a vast majority of people at night. Though there is no real reason why this happens, it is a frequently reported occurrence.18
Nocturnal foot cramps can also be related to circulation disorders, especially in older people, so its important that you talk to your doctor if your cramps are persistent or stopping you from sleeping.19
How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
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Why Does Dystonia Occur In Parkinsons Disease
Dystonia in PD is commonly associated with the Wearing Off of the effects of levodopa containing medications , in which the drug treatment becomes ess effective before the next dose of the Sinemet, Madopar or Stalevo is due. This effect is known as Off dystonia and can often occur in the morning on waking up. A person can experience painful muscular spasms and may be unable to get out of bed until the mornings dose of medication begins to take effect. Off dystonia can sometimes be managed by taking a controlled-release levodopa preparation which releases the drug over a four to six-hour period at night, but you should discuss this possibility with your GP or specialist.
Dystonia in PD can also be associated with the action of levodopa itself as the medication reaches its peak effectiveness. This is known as On dystonia and is caused by too much dopamine in the brain over-stimulating the muscles
Finally, dystonia in PD may be unrelated to the dose of levodopa and can occur as a feature of the condition itself. This can happen at any time of the day, but is usually briefer than dystonias related to levodopa.
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