Impact of pain and pain subtypes on the quality of life of patients with Parkinson’s disease

Choi, Seong-Min; Kim, Byeong C.; Jung, Hyun-Jung; Yoon, Geum-Jin; Kang, Kyung Wook; Choi, Kang‐Ho; Kim, Joon‐Tae; Lee, Seung-Han; Park, Man‐Seok; Kim, Myeong-Kyu; Cho, Ki-Hyun

doi:10.1016/j.jocn.2017.08.002

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…In line with the abovementioned link between network integration and cognition, cognitive decline in PD has been associated with decreased functional connectivity (Olde Dubbelink et al, 2014 ; Amboni et al, 2015 ) or deviant coupling between subnetworks of the brain (Putcha et al, 2016 ). Another non-motor symptom is pain (Broen et al, 2012 ; Choi et al, 2017 ), a symptom that is present in about two thirds of patients and has been associated with sleep and mood disturbances, as well as severity of motor symptoms (Broen et al, 2012 ; Defazio et al, 2017 ). Pain in PD has been linked to a functional disconnection between the hippocampus and nucleus accumbens (Polli et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Dynamic Functional Connectivity and Symptoms of Parkinson’s Disease: A Resting-State fMRI Study

Engels

Vlaar

McCoy

et al. 2018

Front. Aging Neurosci.

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Research has shown that dynamic functional connectivity (dFC) in Parkinson’s disease (PD) is associated with better attention performance and with motor symptom severity. In the current study, we aimed to investigate dFC of both the default mode network (DMN) and the frontoparietal network (FPN) as neural correlates of cognitive functioning in patients with PD. Additionally, we investigated pain and motor problems as symptoms of PD in relation to dFC. Twenty-four PD patients and 27 healthy controls participated in this study. Memory and executive functioning were assessed with neuropsychological tests. Pain was assessed with the Numeric Rating Scale (NRS); motor symptom severity was assessed with the Unified Parkinson’s Disease Rating Scale (UPDRS). All subjects underwent resting-state functional magnetic resonance imaging (fMRI), from which dFC was defined by calculating the variability of functional connectivity over a number of sliding windows within each scan. dFC of both the DMN and FPN with the rest of the brain was calculated. Patients performed worse on tests of visuospatial memory, verbal memory and working memory. No difference existed between groups regarding dFC of the DMN nor the FPN with the rest of the brain. A positive correlation existed between dFC of the DMN and visuospatial memory. Our results suggest that dynamics during the resting state are a neural correlate of visuospatial memory in PD patients. Furthermore, we suggest that brain dynamics of the DMN, as measured with dFC, could be a phenomenon specifically linked to cognitive functioning in PD, but not to other symptoms.

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Section: Introductionmentioning

confidence: 99%

Dynamic Functional Connectivity and Symptoms of Parkinson’s Disease: A Resting-State fMRI Study

Engels

Vlaar

McCoy

et al. 2018

Front. Aging Neurosci.

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“…Furthermore, 35% of PD patients are affected by two types of pain, 10% by three, and 2% by four . Pain can become crippling in a subset of PD patients, affect their ability to conduct activities of daily living (ADL), and negatively impact their QoL . Despite the impact of this non‐motor symptom, pain often remains underdiagnosed and undeclared …”

Section: Introductionmentioning

confidence: 99%

“…14 Pain can become crippling in a subset of PD patients, affect their ability to conduct activities of daily living (ADL), 13,19 and negatively impact their QoL. [20][21][22] Despite the impact of this non-motor symptom, pain often remains underdiagnosed and undeclared. 23 PD patients with pain have been found to experience poorer sleep quality and more sleep disorders than patients without pain.…”

Section: Introductionmentioning

confidence: 99%

Relationship of Nocturnal Sleep Dysfunction and Pain Subtypes in Parkinson's Disease

Martinez‐Martín

Rizos

Wetmore

et al. 2018

Movement Disord Clin Pract

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Background Little research has been conducted regarding the relationship between sleep disorders and different pain types in Parkinson's disease (PD). Objective To explore the influence of the various pain subtypes experienced by PD patients on sleep. Methods Three hundred consecutive PD patients were assessed with the PD Sleep Scale‐Version 2 (PDSS‐2), King's PD Pain Scale (KPPS), King's PD Pain Questionnaire (KPPQ), Visual Analog Scales for Pain (VAS‐Pain), and Hospital Anxiety and Depression Scale. Results According to the PDSS‐2, 99.3% of our sample suffered from at least one sleep issue. Those who reported experiencing any modality of pain suffered significantly more from sleep disorders than those who did not (all, P < 0.003). The PDSS‐2 showed moderate‐to‐high correlations with the KPPS (rS = 0.57), KPPQ (0.57), and VAS‐Pain (0.35). When PDSS‐2 items 10 to 12 (pain‐related) were excluded, the correlation values decreased to 0.50, 0.51, and 0.28, respectively, while these items showed moderate‐to‐high correlations with KPPS (0.56), KPPQ (0.54), and VAS‐Pain (0.42). Among the variables analyzed, multiple linear regression models suggested that KPPS and KPPQ were the most relevant predictors of sleep disorders (as per the PDSS‐2), although following exclusion of PDSS‐2 pain items, depression was the relevant predictor. Depression and anxiety were the most relevant predictors in the analysis involving the VAS‐Pain. Regression analysis, considering only the KPPS domains, showed that nocturnal and musculoskeletal pains were the best predictors of overall nocturnal sleep disorder. Conclusions Pain showed a moderate association with nocturnal sleep dysfunction in PD. Some pain subtypes had a greater effect on sleep than others.

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“…Resting tremor, stiffness, loss of balance, trouble speaking, and eventually, neurocognitive decline are the symptoms commonly associated with Parkinson's disease. Lesser known, but severely contributing to the degrading quality of life in Parkinson's, are the various manifestations of chronic pain that can present [6,10,39]. Compared to the general population of similar age, Parkinson's patients have been confirmed to suffer from a significantly higher level and prevalence of pain [5,6].…”

Section: Chronic Pain In Parkinson's Diseasementioning

confidence: 99%

Chronic Pain Treatment Strategies in Parkinson’s Disease

Edinoff

Sathivadivel

McBride

et al. 2020

Neurology International

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Neurological disorders, including Parkinson’s disease (PD), have increased in prevalence and are expected to further increase in the coming decades. In this regard, PD affects around 3% of the population by age 65 and up to 5% of people over the age of 85. PD is a widely described, physically and mentally disabling neurodegenerative disorder. One symptom often poorly recognized and under-treated by health care providers despite being reported as the most common non-motor symptom is the finding of chronic pain. Compared to the general population of similar age, PD patients suffer from a significantly higher level and prevalence of pain. The most common form of pain reported by Parkinson’s patients is of musculoskeletal origin. One of the most used combination drugs for PD is Levodopa-Carbidopa, a dopamine precursor that is converted to dopamine by the action of a naturally occurring enzyme called DOPA decarboxylase. Pramipexole, a D2 dopamine agonist, and apomorphine, a dopamine agonist, and Rotigotine, a dopamine receptor agonist, have showed efficacy on PD-associated pain. Other treatments that have shown efficacy in treating pain of diverse etiologies are acetaminophen, Nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenase-2 (COX-2) inhibitors. Opioids and opioid-like medications such as oxycodone, morphine, tramadol, and codeine are also commonly employed in treatment of chronic pain in PD. Other opioid related medications such as Tapentadol, a central-acting oral analgesic with combined opioid and noradrenergic properties, and Targinact, a combination of the opioid agonist oxycodone and the opioid antagonist naloxone have shown improvement in pain. Anticonvulsants such as gabapentin, pregabalin, lamotrigine, carbamazepine and tricyclic antidepressants (TCAs) can be trialed when attempting to manage chronic pain in PD. The selective serotonin and noradrenaline reuptake inhibitors (SNRIs) also possess pain relieving and antidepressant properties, but carry less of the risk of anticholinergic side effects seen in TCAs. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been shown in multiple studies to be effective against various types of PD associated pain symptoms. Massage therapy (MT) is one of the most common forms of complementary and alternative medicine. Studies have shown that pressure applied during MT may stimulate vagal activity, promoting reduced anxiety and pain, as well as increasing levels of serotonin. In a survey study of PD patients, rehabilitative therapy and physical therapy were rated as the most effective for pain reduction, though with only temporary relief but these studies were uncontrolled. Yoga has been studied for patients with a wide array of neurological disorders. In summary, PD pathology is thought to have a modulating effect on pain sensation, which could amplify pain. This could help explain a portion of the higher incidence of chronic pain felt by PD patients. A treatment plan can be devised that may include dopaminergic agents, acetaminophen, NSAIDs, opioids, antidepressants, physical therapies, DBS and other options discussed in this review. A thorough assessment of patient history and physical examination should be made in patients with PD so chronic pain may be managed effectively.

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Impact of pain and pain subtypes on the quality of life of patients with Parkinson’s disease

Cited by 26 publications

References 29 publications

Dynamic Functional Connectivity and Symptoms of Parkinson’s Disease: A Resting-State fMRI Study

Dynamic Functional Connectivity and Symptoms of Parkinson’s Disease: A Resting-State fMRI Study

Relationship of Nocturnal Sleep Dysfunction and Pain Subtypes in Parkinson's Disease

Chronic Pain Treatment Strategies in Parkinson’s Disease

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