Pain

Key Facts

  • Most people experience some form of pain at some point in the course of the illness.
  • Pain in joints and muscles are more common due to motor symptoms associated with PD.

Clinical Best Practices

  • No evidence-based guidelines available.

Pain in PD can occur for a variety of reasons. Pain occurs in up to 75% of PD patients; it is typically individualized and does not always correlate to stage.

Common Causes

  • Exacerbation of musculoskeletal pain due to immobility/rigidity
  • Dystonia
  • Sensory symptoms (neuropathic pain)

Diagnosis

  • Comprehensive medical history and physical examination
  • “Off” dystonia pain—occurs in the “off” state
  • “Off” sensory symptoms—also in the “off” state
  • Musculoskeletal pain that does not vary with levodopa dosing, improves with movement

Barriers to Diagnosis

  • Patients often do not disclose pain.

Treatment Options

  • Adjust levodopa or other antiparkinsonian medication doses.
  • Encourage exercise and maximum exertion exercises.
  • Use physiotherapy.
  • Recommend conventional narcotics, aspirin, ibuprofen, and other medications that may be helpful.
  • Inject botulinum toxin for dystonia in “off” state.

Important Caveats to Therapy

References: 

Tinazzi M, Recchia S, Simonetto S, et al. Muscular pain in Parkinson's disease and nociceptive processing assessed with CO2 laser-evoked potentials. Mov Disord. 2010;25(2):213-220.