Pain in Parkinson´s Disease: A Cross-Sectional Study of Its Prevalence, Types, and Relationship to Depression and Quality of Life

Abstract

Pain is an important and distressing symptom in Parkinson’s disease (PD). Our aim was to determine the prevalence of pain, its various types and characteristics, as well as its impact on depression and quality of life (QoL) in patients with PD. How pain differs in early- and advanced-stage PD and male and female PD patients was of special interest. One hundred PD patients on dopaminergic medications had a neurological examination and participated in a structured interview on pain characteristics and completed standardized questionnaires. A total of 76% of the patients had pain. The following types of pain were present: musculoskeletal pain accounted for 41% of the total pain, dystonic pain for 17%, central neuropathic pain for 22%, radicular pain for 27%, and other pains (non-radicular low back pain, arthritic, and visceral pain) made up 24%. One type of pain affected 29% of all the subjects, two types 35%, three types 10%, and four types of pain were reported by 2%. All types of pain were more prevalent in advanced-stage PD subjects than in early-stage PD subjects, except for arthritic pain (subclassified under”other pain”). The frequency and intensity of actual, average, and worst experienced pain were significantly more severe in advanced-stage subjects. PD subjects with general pain and in advanced stages were more depressed and had poorer QoL. Depression correlated with worst pain in the last 24 hours and with pain periodicity (the worst depression score in patients with constant pain). QoL correlated with average pain in the last 7 days. Pain is a frequent problem in PD patients, and it worsens during the course of the disease.

Distribution and impact on quality of life of the pain modalities assessed by the King’s Parkinson’s disease pain scale

“…4, 8, 9, 11 The corresponding figures for the present study were: musculoskeletal, 84.8%; dystonic, 33.2%; radicular, 46.1%; central neuropathic, 31.5%; and oro-facial pain, 20.8%. The origin of musculoskeletal pain in PD is complex and is a mixture of nociceptive and neuropathic elements complicated by local joint related pain as well as parkinsonian rigidity and postures such as dystonia.…”

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

“…9,10 On the other hand, using the King's Parkinson's Disease Pain Scale (KPPS), 11 the syndromic nature of pain has been formally subdivided into several patterns. Prior research has shown that the prevalence of pain is 68 to 81% in PD patients [12][13][14] and that it can be manifested in several modalities, such as musculoskeletal (41-89%), dystonic (15-17%), radicular-neuropathic (27-32%), and central pain (4-22%). 2,12,[14][15][16][17][18] Furthermore, 35% of PD patients are affected by two types of pain, 10% by three, and 2% by four.…”

Pain perception in Parkinson’s disease: A systematic review and meta-analysis of experimental studies

“…While this contrasts with clinical surveys which have shown the frequency and intensity of pain to be greater in advanced-stage compared to early-stage PD [59], this research refers primarily to musculoskeletal pain. While disease progression would be expected to intensify this type of pain due to increasing muscle rigidity or postural abnormalities [13], our findings suggest that changes in sensitivity to noxious input may occur early on and be relatively independent of motor function degradation.…”