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when carefully questioned, more than half of all people with Parkinson's disease say that they have experienced painful symptoms and various forms of physical discomfort. Most people experience aching, stiffness, numbness and tingling at some point in the course of the illness. For a few of them, pain and discomfort are so severe that they overshadow the other problems caused by the disease. This article will address these overlooked painful symptoms of PD, and describe an approach to diagnosing and treating the various pain syndromes that may occur.
Pain syndromes and discomfort in Parkinson's usually arise from one of five causes: (1) a musculoskeletal problem related to poor posture, awkward mechanical function or physical wear and tear; (2) nerve or root pain, often related to neck or back arthritis; (3) pain from dystonia, the sustained twisting or posturing of a muscle group or body part; (4) discomfort due to extreme restlessness and (5) a rare pain syndrome known as "primary" or "central" pain, arising from the brain.
It takes diagnostic skill and clinical experience to determine the cause of pain in someone with PD. The most important diagnostic tool is the patient's history. Where is the pain? What does it feel like? Does it radiate? When does it occur during the day? Does it occur in relation to any particular activity or medication? Perhaps the most important task for people with Parkinson's who experience pain is to describe as accurately as they can whether their medications induce, aggravate or relieve their pain.
Musculoskeletal pain
Hip pain, back pain and neck pain are all common painful complaints in PD. With prolonged immobility of a limb, band-like tendons, termed contractures, may occasionally develop, usually in the hands or feet; one example is the clenched fist contracture that may occur with prolonged flexion of a hand.
Radicular and neuritic pain
Pain that occurs close to a nerve or nerve root is described as neuritic or radicular pain. The classic root-pain syndrome is sciatica, caused by compression or inflammation of the L5 lumbar root. Patients usually describe root pain as a sharp, lightning-like sensation that radiates towards the end of a limb.
Pain associated with dystonia
Dystonia in PD may affect the limbs, trunk, neck, face, tongue, jaw, swallowing muscles and vocal cords. A common form of dystonia in PD involves the feet and toes, which may curl painfully. Dystonia may also cause an arm to pull behind the back, or force the head forward towards the chest.
The most important step in evaluating painful dystonia is to establish its relationship to dopaminergic medication. Does the dystonia occur when the medication is at peak effect? Or does it occur as a "wearing-off" phenomenon, when the benefits of medication are waning? The answers to these questions will usually clarify the nature and timing of the dystonia, and determine its treatment.
Akathisia
No discussion of physical discomfort in PD is complete without a mention of akathisia, or restlessness, a frequent and potentially disabling complaint. Some patients with parkinsonian akathisia are unable to sit still, lie in bed, drive a car, eat at a table or attend social gatherings. As a result of akathisia, patients may lose sleep or become socially isolated.
Central pain syndromes
The most alarming pain syndrome in patients with PD is also one of the rarest: "central pain." This affliction - which is presumed to be a direct consequence of the disease itself, not the result of dystonia or a musculoskeletal problem - is described by patients as bizarre unexplained sensations of stabbing, burning and scalding, often in unusual body distributions: the abdomen, chest, mouth, rectum or genitalia.
Depression and pain
It has long been known that chronic pain can induce depression, and depressed patients often experience pain. People who have PD are themselves at a higher-than-average risk for developing depression, which occurs in some 40 percent of patients at some point during the illness. It is therefore important that any assessment of pain in an individual with PD take into account the potential contributing role of depression, which may also require treatment.
Many patients with PD experience pain at some point during the illness. The complaint is often overlooked because PD is primarily a motor disorder. Yet, for a minority of patients, pain and discomfort can be so debilitating that they dominate the clinical picture. It is therefore important that individuals who experience pain discuss the problem with their neurologist. A careful history and examination - including, in some cases, additional diagnostic testing - can usually determine the cause of the pain. Depending on the category of painful complaint - musculoskeletal, root or nerve pain, dystonic muscle spasm, akathisia or central pain - it is usually possible for the physician to design an effective treatment plan.
10 Questions your doctor will ask you about pain:
1.Where is your pain located?
2.What does your pain feel like?
3.Does the pain radiate anywhere?
4.When does the pain occur?
5.Do you have pain continuously, or only at certain times?
6.Does the pain occur in relation to any particular activity?
7.What relieves the pain?
8.What makes the pain worse?
9.Do your anti-Parkinson's medications relieve your pain?
10.Do you have arthritis?
Note from RoyProp:
When cancer spreads from the prostrate gland you may experience hip and lower back pain. Painful, and what I currently experience.
Exam and xray of my hip by ortho doc, negative joint cause; My neurologist does not say its cause as PD. I went yesterday to my family physician for testing, all clear.
I continue to search for a cause of my hip and back pain. I suspect my neurologist is not seeing the big picture.
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