Pain in Gilles de la Tourette Syndrome and Related Tic Disorders

Abstract

Although pain is not generally recognized as a symptom of tic disorders, we have seen a number of patients in whom this was a prominent feature, at times even the symptom of greatest concern. The commonest pain complaints are those arising from the actual performance of a tic. Most often this follows directly from the discomfort produced by sudden or repeated extreme exertion. Here the origin of the pain is usually musculoskeletal, though rare examples of neuropathic pain may occur. Pain also may arise from striking or being struck by a moving body part involved in large amplitude tics. Other related painful acts include deliberate self-injury and pain inflicted upon others. A second major category is represented by a smaller number of patients who complain of pain during voluntary efforts to suppress their tics. Finally, there are patients who obtain relief from tics while experiencing pain, to such an extent that they will deliberately provoke pain to obtain its benefit. We feel that pain should be recognized as a common complaint, and occasionally a source of significant disability, in patients with tics. RESUME: La douleur dans le Syndrome de Gilles de la Tourette et les affections connexes Meme si la douleur n'est generalement pas consideree comme un symptome des affections caracterisees par la presence de tics, nous avons observe un certain nombre de patients chez qui la douleur etait un element important, etant a certains moments le symptome qui provoquait le plus d'anxiete. Les plaintes les plus frequentes sont celles qui proviennent de I'accomplissement du tic lui-meme, ceci resultant le plus souvent du malaise engendre par un effort intense, subit ou repet6. L'origine de la douleur est alors habituellement musculosquelettique, quoique, dans de rares cas, elle puisse etre d'origine neuropathique. La douleur peut aussi etre provoquee par Taction de frapper ou d'etre frappe par une partie du corps en mouvement lors de tics de grande amplitude. D'autres actions peuvent egalement engendrer de la douleur: les blessures que le patient s'inflige deliberement ou qu'il inflige aux autres. Une deuxieme categorie importante de patients, moins nombreuse, se plaint de douleur lors d'efforts volontaires pour supprimer leurs tics. Finalement, il y a des patients qui obtiennent un soulagement de leurs tics quand ils eprouvent de la douleur, a tel point qu'ils s'infligent deliberement de la douleur pour en obtenir ce benefice. Nous estimons que la douleur devrait etre consideree comme un symptome frequent chez les patients qui presentent des tics et que cette douleur peut occasionnellement provoquer une incapacity importante.Can. J. Neurol. Sci. 1989; 16:439-441 Pain is rarely discussed in the context of tic disorders, yet we have been impressed that for many of our patients with tics, pain represents a significant feature of their illness. We wish to briefly describe examples of pain in relation to tics and propose a classification of this association. CASE REPORTS Patient 1A 9-year-old girl had a 4-year h...

European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

“…Striking or being struck by a moving body part involved in large amplitude tics may also cause pain and is sometimes difficult to distinguish from deliberate self-injury. Additionally, some patients obtain relief from tics while experiencing pain, to such an extent that they will deliberately provoke pain to obtain benefit [193]. A smaller number of patients complain of pain associated with the irresistible urge to tic or with aggravating premonitory urges during voluntary efforts to suppress their tics.…”

Exploring the Impact of Chronic Tic Disorders on Youth: Results from the Tourette Syndrome Impact Survey

“…The PedsQL-SF15 includes parallel child self-report and parent-report formats, as well as versions for children (ages 8-12) and adolescents (13)(14)(15)(16)(17)(18). In the current study, 4 different versions of the PedsQL-SF15 were administered depending on the respondent (parent or child) and the child's age (child or teen).…”

“…Specifically, tic performance may result in neuropathic pain or tissue damage (e.g., headaches, neck and shoulder pain, stress fractures) [14,15]. Adverse effects on the family can include high caregiver strain [16,17] and stress [18,19].…”

Orofacial pain and oromotor disorders

“…Dans de tels cas, la douleur peut être d'origine musculosquelettique mais peut aussi découler de complications neuropathiques ou auto-infligées [45]. Les approches bénéfiques utilisées pour les tics d'intensité modérée à sévère incluent la tétrabénazine, le clonazépam, la clonidine (agoniste adrénergique des récepteurs alpha-2), de même que les antipsychotiques dans certains cas sélectionnés.…”