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 Parkinsons Disease, vol. 10, no. s1, pp. S37-S48, 2020
Abstract
Negative Impact Of Severity Of Pain On Mood Social Life And General Activity In Parkinsons Disease
This case control study designed for clinicians and rehabilitation specialists to effectively identify pain from the patients point of view determined that PD patients had significantly higher pain severity scores compared to controls. PD patients with depressive symptoms had significantly higher pain severity and pain interference scores than controls without depressive symptoms. PD patients reported greater scores on Global BPI pain interference and all components of the pain interference subscale. Therefore, PD and depression seem to be correlated with higher perceived pain, severity and interference. A report on this study, by Jose Marques Lopes, PhD., was published in Parkinsons News Today, September 21, 2018.
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What Kinds Of Pain Can Be Part Of Parkinsons
At its simplest, pain means the body hurts. When a person feels pain, nerves in the skin, joints and organs alert the brain to the location of an injury. Researchers have found that in early PD, there are already changes in the way that the body detects and regulates pain. Pain is complex and can take many forms. In PD, pain tends to affect the side of the body where motor symptoms first appeared. If your PD started with a tremor in the right hand, youre more likely to develop pain in the right shoulder, wrist or fingers. Here are a few common types.
Musculoskeletal pain
Musculoskeletal pain is experienced by up to 75 percent of people with PD and includes pain in the muscles, bones or skeleton. It is related to rigidity and decreased movement, and to arthritis. Many people with PD experience muscle cramps and tightness in the neck, spine and arms. Muscles may feel stiff or achy. Joint pain, especially in one shoulder, is also common. Its not uncommon for people with PD to be diagnosed with frozen shoulder or rotator cuff problems, and even undergo surgery.
Dystonic pain
Neuropathic pain
Central pain
Central pain affects about 10 percent of people with PD at some point. It can be difficult to describe but may include a vague, constant boring sensation abdominal pain, reflux, shortness of breath or feeling flushed painful sensations around the mouth, genital or rectal areas or simply pain all over.
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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 Does Parkinsons Rigidity Feel Like
Rigidity, while seldom the main symptom early in Parkinsons, is experienced as a stiffness of the arms or legs beyond what would result from normal aging or arthritis. Some people call it tightness in their limbs. Stiffness can occur on one or both sides of the body and contribute to a decreased range of motion.
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Common Skeletal & Bone Changes With Pd
- Frozen shoulder: stiffness, pain and loss of range of movement in the shoulder, many people experience this symptom before a PD diagnosis.
- Flexed fingers, toes or feet : one finger may extend, the thumb may fold inwards, fingers may clamp down onto the palm. In the leg, the foot may flex down or turn in, the big toe may flex upward while the other toes curl under.
- Stooped posture : the spine bends forward when walking, in the most severe cases by as much as 90 degrees. This posture arises because the hips and knees are flexed and will go away when lying down.
- Leaning sideways : involuntarily tilting of the trunk to one side when sitting, standing or walking always to the same side.
- Scoliosis: sideways twisting, or curvature, of the spine.
- Dropped head : the head and neck flex forward the chin may drop all the way down to the sternum or breastbone .
- Bone fractures: people with PD are at risk of broken bones from falling, especially from landing on the hip. Kneecap fractures also are common, painful and sometimes overlooked.
- Low bone density/osteoporosis: bones may become weak and at risk for osteoporosis from lack of weight-bearing exercise, like walking, and from too little calcium and vitamin D. Other risk factors for osteoporosis include older age, female sex, low body weight, and smoking. A person with PD who has osteoporosis is more likely to break a bone if they fall.
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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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.
Parkinsons Disease Risk Factors
- Age: In most cases, people do not develop noticeable signs of Parkinsons disease until they are 60 or older. Only in about 10 percent of cases or less do people develop early onset Parkinsons disease .
- Gender: Men are twice as likely to develop Parkinsons than women. In addition, women tend to be on average two years older than men they develop PD.
- Family history: Around 15 percent of people with Parkinsons have a family member with this condition.
- Ethnicity: Hispanics and Caucasions have the highest incidence of Parkinsons disease while African Americans and Asians have the lowest incidence.
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If You Experience Stiffness In Your Shoulder It May Be Due To Parkinsons
While those with Parkinsons may experience stiffness in several body parts, experts say that having frozen shoulder, also known as adhesive capsulitis or periarthritis, is particularly linked with PD. Shoulder stiffness is, in fact, one of the conditions associated with Parkinsons disease, a neurodegenerative disorder caused by a lack of dopamine in the brain, explains Very Well Health.
When a patient develops frozen shoulder, the connective tissues that encase the bones, ligaments, and tendons in that area thicken and tighten around the shoulder joint. When this happens, movement becomes restricted, causing pain and stiffness.
According to the Mayo Clinic, symptoms of frozen shouldertypically begin gradually, worsen over time and then resolve, usually within one to three years. The health authority says this often occurs in three distinct stages: the freezing stage, the frozen stage, and the thawing stage. In the freezing stage, the patient typically experiences reduced range of motion along with joint pain in one shoulder. The frozen stage is typically less painful, but as the shoulder becomes stiffer, many people lose most or all function in the affected shoulder. In the thawing stage, the patient begins to regain range of motion.
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Chiropractic Care For Low Back Pain Gait And Posture In A Patient With Parkinsons Disease: A Case Report And Brief Review
Eric Chun Pu Chu1^, Arnold Yu Lok Wong2^, Linda Yin King Lee3
1 New York Chiropractic and Physiotherapy Centre , 41/F Langham Place Office Tower , Hong Kong, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong , School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong , China
^ORCID: Eric Chun Pu Chu, 0000-0002-0893-556X Arnold Yu Lok Wong, 0000-0002-5911-5756.
Correspondence to:
Keywords: Chiropractic back pain gait cyclogram Parkinsons disease walking difficulty
Received: 18 April 2021 Accepted: 09 June 2021 Published: 25 October 2021.
doi: 10.21037/acr-21-27
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Ocean Trial Testing If Ongentys Can Ease Pain Of Motor Fluctuations
According to an article published in 2018 in Frontiers in Neurology, both low back pain and Parkinsons are associated with impaired proprioceptive function, sensory orientation during standing balance, anticipatory postural adjustments, automatic postural responses, and striatal-cortical function.
All of those are present as I wobble and weave through my off periods. Neck and back pain are more intense on the right side, but its subtle and hard to distinguish when the spasms are happening.
The authors of the Frontiers in Neurology article go on to suggest that it may not be so implausible to consider as an axial parkinsonism, rendering it the most prevalent parkinsonism in the world.Axial parkinsonism symptoms include gait freezing, postural instability, and trunk posture alterations and can have a significant impact on patients quality of life. Moreover, these symptoms are poorly responsive to dopaminergic drugs and surgical therapies.
In a 2008 article published in The Journal of the Canadian Chiropractic Association, a chiropractic doctor noted how early Parkinsons without tremor imitated mechanical back pain. During a follow-up visit with the patient after the official Parkinsons diagnosis, the provider noted that something started to change about a year earlier.
The articles author wrote:
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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Lower Back Pain And Disability Assessment
After giving their informed consent, participants completed the OLBPD, which was given within 1 month preoperatively and at the 6-month and 1-year follow-up appointments to track changes in pain. The OLBPD has 10 categories , and patients are scored from 0 to 100% into categories of minimal disability , moderate disability , severe disability , crippling back pain and bedbound . Questions evaluate how the patient had been feeling over a period of time prior to answering the questionnaire with their medication and stimulator on. Participants were also asked preoperatively and 1 year postoperatively to rate their global pain on the Visual Analogue Scale of 0-10 while on medication. These scores represent how the patient was feeling right at that moment. Autonomic dysfunction was assessed at the same time points using the Scales for Outcomes in Parkinson’s Disease-Autonomic , and sleep dysfunction was assessed using the Parkinson’s Disease Sleep Scale . Depression and anxiety were assessed preoperatively and 1 year postoperatively in the patients’ standard neuropsychological evaluation using Beck’s Depression Inventory and the State-Trait Anxiety Inventory, respectively. All clinical assessments were completed with a research associate present to assist with writing, as this is often difficult in this patient population off medication. The research assistant acted as a scribe and did not influence the answers given by the patients.
Parkinsons Pain Can Be Linked To Depression
If exercise and/or adjusting your medications do not help with the pain, ask yourself and your doctor if you might be depressed. Pain in Parkinsons disease is linked to depression, and treating the depression may help to diminish any persistent pains. Depression affects about 40% of people with Parkinsons. In some cases, psychotherapy may alleviate pain from Parkinsons.
If you dont 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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Can Parkinson’s Disease Be Cured
No, Parkinson’s disease is not curable. However, it is treatable, and many treatments are highly effective. It might also be possible to delay the progress and more severe symptoms of the disease.
A note from Cleveland Clinic
Parkinson’s disease is a very common condition, and it is more likely to happen to people as they get older. While Parkinson’s isn’t curable, there are many different ways to treat this condition. They include several different classes of medications, surgery to implant brain-stimulation devices and more. Thanks to advances in treatment and care, many can live for years or even decades with this condition and can adapt to or receive treatment for the effects and symptoms.
What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
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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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Talking To Your Healthcare Provider
How do you know if your neck pain is potentially related to your Parkinsons disease?
You cant know for sure, but you and your healthcare provider can explore the issue. If you have been diagnosed with Parkinsons disease, it is important that you and your doctor consider other causes of your neck pain. Thats because the treatment for Parkinsons disease will not help the pain if its caused by arthritis, muscle strain, or a more serious medical issue.
Complementary Treatments For Back Pain
Massage therapy and acupuncture are two complementary treatments that are often used for pain. There have been small studies investigating the use of massage therapy and acupuncture for motor symptoms of PD, but more studies are necessary to s determine if they specifically help with PD pain. You can also view a Q+A about complementary treatments in PD.
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How Does This Condition Affect My Body
Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.
Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.
When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.
As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.