In the past, many descriptions of
Parkinson’s disease didn’t mention pain as being a significant symptom, the
standard explanations usually focusing on the motor aspects of
the disease. Of course these definitions are not incorrect but this
disease challenges us in many ways and dealing with
pain, is no exception. And it is one issue that often
significantly affects quality of life, which is something none of us want to
lose…it is much too important and unfortunately very often, difficult to
maintain. Yet we continue to pursue it, committed to remaining as active
and productive for as long as this disease allows.
Pain in fact is a frequent
complaint in PD. It is estimated that 35 – 80% of Parkinson’s patients
experience significant discomfort. This statistic represents quite a wide
variability due to difficulty in studying something as subjective as pain –
lack of standardized definitions and consistent assessment tools being real
challenges. Regardless of its prevalence, by restricting mobility,
interfering with sleep and affecting mood among other issues, pain in
Parkinson’s can interfere with an individual’s daily functioning and life.
Most of the time, discomfort in
muscles and joints is secondary to the motor features of Parkinson’s - 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 predominate of the side more affected by
parkinsonism.
But there are many other categories
of pain associated with Parkinson’s disease. Radicular or neuropathic
pain is experienced as numbness or tingling, or a sensation of coolness in
a part of the body, usually secondary to a pinched nerve because of something
like a slipped disc or in some Parkinson’s patients is due to the strong and
prolonged muscle spasm that can occur.
Dystonia – related pain
occurs as its name suggests, at times of dystonia
(prolonged, painful contraction of a muscle) 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 Parkinson’s can face.
Akathitic 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.
Primary or central pain in Parkinson’s is a direct consequence of the disease itself and
is not due to secondary causes. It can be described as a painful,
burning, stabbing, aching, itching or tingling occurring in undefined areas of
the body. This type of pain can be quite relentless and distressing.
Most often it is a combination of
many different causes (multifactorial) but regardless of the type of pain, its
presence can adversely affect health-related quality of life measures and in
some people can even overshadow the motor symptoms of the disease.
And fact is that even though it has
a significant detrimental effect on quality of life, pain in Parkinson’s is often
undertreated. Diagnosing the source of pain in Parkinson’s disease can be
difficult and is often a diagnosis of exclusion, meaning that all other
possible non-PD related causes are ruled out first. But once diagnosed
and classified, management can be directed towards treating the potential cause
or at least relieving some of the debilitating symptoms.
There are interventions that
you can implement in order to alleviate some of the discomfort along with a
number of medication adjustments or additions that your physician can attempt
that may also be of some benefit. Pain in Parkinson’s disease is a real
and serious phenomenon. Minimizing the amount of pain that you experience
is a necessity and a worthwhile focus for you and members of your health team.
References Used:
Ford, Blair, MD. "Pain in
Parkinson's Disease." Weblog post. Parkinson's Disease Foundation.
N.p., Winter 2005. Web.
Olanow, C. W., MD, F. Stocchi, MD,
and Anthony E. Lang, MD. "Pain and Paresthesia in Parkinson's
Disease." Parkinson's Disease: Non-motor and Non-dopaminergic Features.
Chichester, West Sussex, UK: Wiley-Blackwell, 2011. 315-32. Print.
Sorbo, Francesca Del, MD, and
Alberto Albanese, MD. "Clinical Management of Pain and Fatigue in
Parkinson's Disease." Parkinsonism & Related Disorders 18
(2012): S233-236. Web.
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