Central Pain in Parkinson's Disease
What It is and How to Cope With It
From Patrick McNamara, Ph.D., former About.com Guide
Updated April 09, 2009
About.com Health's Disease and Condition content is reviewed by the Medical Review Board
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Most pains from Parkinson's disease1 are due to the immobility imposed on you by the disease. Cramps, contractures, stiffness and rigidity all can usually be treated with a combination of optimal dopamine replacement therapy2 and exercise or physical therapy. Central pain syndromes of PD, however, require something more than standard treatments for PD.
Central pain is pain produced by abnormal function of the brain’s processing system for sensation and pain. It's not like you can massage a muscle and have the pain go away -- tThe source of the pain in central pain is NOT a muscle cramp or even a damaged internal organ. Instead, the source is in the brain itself, so it is there that doctors go to treat pain of central origin.
Researchers believe that central pain of PD may result from abnormalities of sensory pathways in the basal ganglia3 and perhaps also in the thalamus. The basal ganglia are a collection of nerve groups deep in the center of the brain that typically help to coordinate complex movements but they also process sensations related to movements. The thalamus is known as a relay from the "periphery," the limbs and the body, to the center-the brain. The thalamus gathers up all the sensations in the body and sends them up to the thinking centers of the brain where they are evaluated for significance. If either the basal ganglia or the thalamus alter their functioning due, for example, to loss of dopamine4, they may start to erroneously interpret sensations as pains. Then you begin to fell pains coming from nowhere in particular -- but nevertheless feeling quite severely "painful."
How It Feels
Pains of central origin can be felt as stabbing, burning, piercing, scalding and so forth. They can be felt in any part of the body. Nothing really relieves this sort of pain. No repositioning of the body can do so. Even sleep sometimes provides no real relief. Each person is different. Sometimes opiates will provide relief, sometimes not. Sometimes opiates combined with anti-depressants helps, sometimes not. Sometimes subcutaneous injections of the dopaminergic apomorphine into the region of pain helps, sometimes not.
How to Get Help
The best person to guide you in your search for relief from a central pain is a pain specialist who consults with your PD specialist. It may be a combination of opiates, anti-depressants, exercise and adjustments in your PD meds. Whatever it is, it is worth pursuing until you find what works for you.