What Is Your Advice On Footwear For People With Parkinsons
Make sure your shoes fit well, as shoes that dont fit correctly can damage your feet and increase the risk of tripping or falling.
Try to choose shoes that have a low, broad heel, and that fasten over the top of the foot close to the ankle. Shoes with laces, Velcro or a strap and buckle have a better hold on the foot.
Leather-soled shoes should be avoided as they can increase the risk of trips and falls.
What Can You Do To Prevent Leg Cramps At Night
Unfortunately, the treatment options are limited since no one knows what causes leg cramps in the first place. Over the years, doctors have recommended magnesium supplements, muscle relaxants, and calcium channel blockers, cardiovascular medicine, but none of them seem to have great success in reducing nocturnal leg cramps. We used to recommend tonic water because tonic water has quinine but it turns out that quinine has all kinds of issues, says Dr. Fisher. Quinine, an organic compound from the bark of a South American tree, is no longer used to treat leg cramps at night because of its potential for serious and adverse effects such as cardiac arrhythmias and a condition that causes low blood platelet count. These are the 14 other medications pain doctors avoid treating their patients with.
When Can Dystonia Occur
Each persons experience with Parkinsons and dystonia is unique. Dystonia can occur unexpectedly or during repetitive actions, such as writing or golfing. It can be brief or prolonged. It can occur as a response to your levodopa therapy, even if your medication is working optimally. And, it can occur at different times throughout the day or can be cyclical.
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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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Parkinsons & Restless Leg Syndrome: Using Dopaminergic Medication
Because RLS is well-treated by medications that also treat PD, it is likely that some aspect of brain dopamine function is altered in RLS. However, unlike in PD, in which the deficit in substantia nigra dopamine-producing cells can be proven in many ways, no such abnormality has been shown in RLS. For example, studies show that DaTscan results are not abnormal in RLS.
Using dopaminergic medications to treat RLS however can be tricky. In some people they can lead to a phenomenon known as augmentation, in which long term use of dopaminergic medications can worsen the symptoms making them appear earlier in the day or migrating to the upper body in addition to the legs.
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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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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.
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What Are The Different Types Of Pain Experienced By People With Parkinsons
Five main types of pain are common for people with Parkinsons. Multiple types may be present simultaneously or occur at different points throughout a persons path with Parkinsons. Recognizing which kind of pain is present can help you optimize treatment, as can paying attention to what activities or times of day make your pain better or worse.
Musculoskeletal pain
Musculoskeletal pain that affects muscles, bones, tendons, ligaments, and/or nerves. The pain can be localized or generalized and can fade or intensify at different times. Existing musculoskeletal pain can be exacerbated by Parkinsons.
Neuropathic pain
Rather than being caused by a physical injury, this type of pain is caused by damage to the somatosensory nervous system or a disease affecting the somatosensory nervous system, which responds to external stimuli like touch, temperature, and vibration. It tends to be fairly consistent throughout the day and is present no matter what activity youre doing. Unlike the aching you may feel when youre doing a strenuous physical activity, neuropathic pain feels more like a tingly, crawly, uncomfortable sensation.
Dystonic pain
Dystonia, the movement disorder in which involuntary muscle contractions cause repetitive or twisting motions, is often very painful. Many people with Parkinsons experience dystonia as a motor symptom, whether its localized , in multiple nearby body parts , or all over .
Akathisia
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What Causes These Leg Cramps At Night
Since the condition is not very well understood in the medical world, perplexed doctors still cant pinpoint why these nocturnal leg cramps occur at all. Theres no underlying disorder that causes it which makes it frustrating because theyre super common and really hard to treat, says Dr. Fisher. But the underlying ideology is thought to be a neuromuscular problem where the nerves are firing off and the muscles are cramping because of it. Even though theres likely no apparent cause for these nocturnal leg cramps, the Mayo Clinic and Cleveland Clinic cite dehydration, muscle fatigue, sitting for long periods of time, and standing on concrete floors, as just a few of the potential causes. If your muscles are not getting enough hydration, youre not carrying the right amount of oxygen to your muscles and youre not carrying away the toxins, says Dr. Fisher. Its like if an elite athlete would get a cramp, they try to hydrate, which helps to relieve them and the same goes for muscles, which tend to cramp less if youre in a well-hydrated state. Besides neglecting to drink eight glasses of water a day, these are the 7 other mistakes that make the pain worse.
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Philip Tindall Says He Tried To Ignore His Parkinsons
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Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. You may experience signs in your feet and toes. Men aged 50 to 89 are 1.4 times more likely to be diagnosed with Parkinsons than women, according to Parkinsons UK charity.
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person.
Common symptoms include muscle twisting, spasms or cramps, according to the Cleveland Clinic.
It adds: You may experience a painful cramp in your foot or curled and clenched toes.
The most common symptoms also include a tremor. Shaking tends to begin in your hands and arms, though it can also occur in your jaw or foot.
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The health site adds that people may also experience slowness of movement, rigid muscles and stiff limbs.
Rigidity is the inability of your muscles to relax normally.You may experience aches or pains in the affected muscles and your range of motion may be limited.
Some people will also find that they are unsteady when they walk.
Other signs include depression and anxiety, as well as memory issues.
Treatment Of Rls In Pd
Regardless of the above discussion, it is clear that many people with PD have difficulty falling asleep because of annoying sensations in the legs accompanied by a sometimes unbearable sense of restlessness in the legs. For these people, taking dopamine agonists before bed can be helpful. Caution is in order, of course, because in some patients with PD, especially older or more advanced patients, these medications can cause confusion and hallucinations and are thus not well-tolerated. A long-acting levodopa formulation or medications such as gabapentin, gabapentin enacarbil and pregabalin can also be effective. Trying to address sleep issues such as RLS in patients who have sleep complaints can be an important aspect of maximizing therapy for PD.
Tips and Takeaways
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What Does Dystonia Feel Like
For some people, dystonia feels like a Charlie horse, which can be so painful that it wakes you up at night. For some, it feels like opposing muscles, muscles that work in pairs, are competing with each other. For example, when your bicep muscle contracts, your tricep muscle relaxes or elongates. In dystonia, both muscles want to contract at the same time, and it feels like theyre fighting. For some people living with Parkinsons, dystonia is the most distressing symptom they experience.
Types Of Parkinsons Pain
Most of the time, discomfort in muscles and joints is secondary to the motor features of Parkinsons lack of spontaneous movement, rigidity, and abnormalities of posture what is known as musculoskeletal pain. The most commonly painful sites are the back, legs, and shoulders and it is usually more predominant on the side more affected by parkinsonism.
But there are many other categories of pain associated with Parkinsons disease. Radicular or neuropathic pain is experienced as a sharp pain that can start in the neck or lower back with radiation to arm or leg respectively and is often associated with numbness or tingling, or a sensation of coolness in the affected limb. It is usually secondary to a pinched nerve due to something like a slipped disc.
Dystonia related pain occurs as its name suggests, at times of dystonia most often experienced in the foot, neck or face and arm at different points in the dosing schedule, particularly the off phase when there is not enough dopamine replacement but can uncommonly also occur at peak-dose times. It can be one of the most painful symptoms those with Parkinsons can face.
Akathisia pain is experienced as restlessness, a subjective inner urge to move, an inability to stay still and the inherent feelings of discomfort that it brings. It is primarily experienced in the lower limbs and can often be relieved by walking around.
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What Is The Difference Between Leg Cramps And Restless Legs Syndrome
Although both nocturnal leg cramps and restless legs syndrome tend to happen to you at night or when youre at rest, restless legs syndrome doesnt cause the severe pain. Restless legs syndrome is uncomfortable, but not agonizing. Its a crawling sensation that makes you want to move your legs. When you do move, the restlessness stops, but there is still discomfort.
Causes Of Leg Cramps In Seniors
Aging causes a natural shortening of tendons and result in leg muscle cramps. It is estimated that about 75% of leg cramps occur at bedtime or during the night and can disturb the sleep pattern.
Statistics indicate that most adults above the age of 50 will experience leg cramps at least once while adults over 60 years of age are 33% more likely to have a leg cramp at night at least once every two months . Night leg cramps in seniors are not uncommon.
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What Medicines May Help With Leg Cramps
At this time, there is no recommended medication that can prevent leg cramps 100% of the time. However, there are some prescription medications that show a little evidence of preventing leg cramps. Under your healthcare providers watchful eye, you might want to try the following:
- Carisoprodol : A muscle relaxant.
- Diltiazem : A calcium-channel blocker.
- Orphenadrine : Treats muscle spasms and relieves pain and stiffness in muscles.
- Verapamil: A calciuim-channel blocker.
Improve Your General Fitness
Increasing your level of fitness will help you manage your weight and ensure your joints arent under any added pressure. You could try walking, swimming, dancing, cycling or aerobics its up to you.
Many of Parkinsons UKs local groups have physiotherapist-led exercise classes you can join. Visit our Local Support page or call our helpline on 0808 800 0303 to find one near you.
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Does Having Rls Increase The Risk Of Developing Pd
Since RLS affects as much as 4-10% of the US adult population, it is clear that the vast majority of those with RLS do not ever develop PD.
Despite this, it still might be the case that RLS increases the risk of subsequently developing PD. There have been many studies trying to figure this out with conflicting results. Some studies show that there is no increased risk and others show that having RLS confers about a two-fold increased risk of developing PD over the general population.
What Parts Of The Body Are Affected By Dystonia
Dystonia is usually worse on the side of the body where the PD symptoms are more pronounced. It can be localised to a single muscle or to a group of muscles, but in people with PD it is most commonly seen in the feet. Spasms in the calf muscles can cause the toes to curl into a claw-like position. The foot may also turn in at the ankle and sometimes the big toe can stick up . This can be very uncomfortable, especially for people who try to fit their feet into tight-fitting shoes. Although most common in the feet, dystonia can occur in other parts of the body.
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Who Does It Affect
The risk of developing Parkinsons disease naturally increases with age, and the average age at which it starts is 60 years old. Its slightly more common in men or people designated male at birth than in women or people designated female at birth .
While Parkinsons disease is usually age-related, it can happen in adults as young as 20 .
Other Less Frequent Dystonic Effects Found In Pd Include The Following:
- A spasm of the hand, often provoked by tasks requiring fine motor control such as handwriting. For this reason it is known as writers cramp and can often begin as a tremor of the hand
- Cervical dystonia or spasmodic torticollis, which is a sustained turning of the head to one side, bending forward or, more rarely, backward
- Blepharospasm, meaning intermittent or sustained eyelid closure caused by the contraction of the eyelid muscles. This can begin in one eye, but will usually continue on to the other eye. Symptoms of this condition include excessive blinking, irritation, a burning sensation in the eyes and photophobia, an abnormal intolerance to light. These symptoms can be aggravated by stress, looking up or down, reading, driving or bright lights
- Spasmodic dysphonia or a spasm of the vocal cords
- Hemimasticatory or hemifacial spasm, a spasm affecting one side of the jaw area or one side of the face
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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.