Pain in Parkinson's disease: new concepts in pathogenesis and treatment

Rukavina, Katarina; Leta, Valentina; Sportelli, Carolina; Buhidma, Yazead; Duty, Susan; Malcangio, Marzia; Chaudhuri, K. Ray

doi:10.1097/wco.0000000000000711

Cited by 68 publications

(54 citation statements)

References 96 publications

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“…The extensive heterogeneity of pain that is experienced in PD patients presents obstacles in identifying targets for treatment. Furthermore, a lack of controlled studies has left a dearth of evidenced based treatment recommendations, and current regimens are largely based on case reports and empirical evidence [83][84][85]. Nevertheless, an array of pharmacological and nonpharmacological treatment options is available to attempt to relieve the chronic pain symptoms of PD patients.…”

Section: Treatment Of Chronic Pain In Parkinson's Diseasementioning

confidence: 99%

“…Monoamine oxidase inhibitors (MAOI-B), such as selegiline, may also be beneficial in treating PD related pain. A post-hoc analysis revealed that safinamide reduced the number of concomitant pain treatments that PD patients relied on, and also the scores of the "bodily discomfort" domain of the Parkinson's Disease Questionnaire-39 [84,94,95].…”

Section: Dopaminergic Agentsmentioning

confidence: 99%

“…Perhaps the most convincing evidence for dopaminergic therapy in the treatment of chronic pain in PD is the observation that many patients report experiencing more pain during their "off states," or times when their medication is not working optimally to control other PD related symptoms, than they do in their "on states" [63,[84][85][86]. While further research is needed to help to refine the use of dopaminergic agents to treat PD related pain, this suggests that optimizing dopaminergic therapy is a valuable step.…”

Section: Dopaminergic Agentsmentioning

confidence: 99%

“…Opioids and opioid-like medications such as oxycodone, morphine, tramadol, and codeine are also commonly employed in treatment of chronic pain in PD. These medications must be used with caution related to the risk of unpleasant neuropsychiatric and GI side effects [84,86]. A multicenter, double-blind, randomized, placebo-controlled trial showed that Targinact, a combination of the opioid agonist oxycodone and the opioid antagonist naloxone, was significantly better than placebo in delivering pain relief.…”

Section: Other Pharmacologic Agentsmentioning

confidence: 99%

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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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Section: Treatment Of Chronic Pain In Parkinson's Diseasementioning

confidence: 99%

Section: Dopaminergic Agentsmentioning

confidence: 99%

Section: Dopaminergic Agentsmentioning

confidence: 99%

Section: Other Pharmacologic Agentsmentioning

confidence: 99%

See 2 more Smart Citations

Chronic Pain Treatment Strategies in Parkinson’s Disease

Edinoff

Sathivadivel

McBride

et al. 2020

Neurology International

View full text Add to dashboard Cite

show abstract

“…Several syndromes are hypothesized to be involved in PD pain generation [10]. Generally, PD patients suffer from alterations in peripheral transmission, sensitive-discriminative processing, pain perception and pain interpretation in multiple levels, due to neurodegenerative changes in dopaminergic pathways, and non-dopaminergic pain-related structures [11].…”

Section: Introductionmentioning

confidence: 99%

New Approaches Based on Non-Invasive Brain Stimulation and Mental Representation Techniques Targeting Pain in Parkinson’s Disease Patients: Two Study Protocols for Two Randomized Controlled Trials

et al. 2021

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Pain is an under-reported but prevalent symptom in Parkinson’s Disease (PD), impacting patients’ quality of life. Both pain and PD conditions cause cortical excitability reduction and non-invasive brain stimulation. Mental representation techniques are thought to be able to counteract it, also resulting effectively in chronic pain conditions. We aim to conduct two independent studies in order to evaluate the efficacy of transcranial direct current stimulation (tDCS) and mental representation protocol in the management of pain in PD patients during the ON state: (1) tDCS over the Primary Motor Cortex (M1); and (2) Action Observation (AO) and Motor Imagery (MI) training through a Brain-Computer Interface (BCI) using Virtual Reality (AO + MI-BCI). Both studies will include 32 subjects in a longitudinal prospective parallel randomized controlled trial design under different blinding conditions. The main outcomes will be score changes in King’s Parkinson’s Disease Pain Scale, Brief Pain Inventory, Temporal Summation, Conditioned Pain Modulation, and Pain Pressure Threshold. Assessment will be performed pre-intervention, post-intervention, and 15 days post-intervention, in both ON and OFF states.

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Saponin‐Encapsulated Microbubbles Protect Dopaminergic Neurons from MPTP‐Induced Oxidative Stress Injury

Zhang

et al. 2023

Advanced Therapeutics

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Parkinson's disease (PD) is starting at younger ages. In order to reduce the risk of PD in young people, Rb3 is selected as an active ingredient and assembled into Rb3 nanoparticles (Rb3NPs)encapsulated microbubbles (MBs), shorted for Rb3NPs@MBs. This study uses focused ultrasound‐mediated Rb3NPs@MBs to cross the blood–brain barrier and reach the brain lesions to be intervened in in order to explore the prevention of 1‐methyl‐4‐phenyl‐4‐piperidinpropionate ester (MPTP)‐induced PD by Rb3NPs@MBs and its related mechanisms. In the present study, Rb3NPs@MBs prevent MPTP‐induced tyrosine hydroxylase (TH)‐positive cell decreases, decrease TH expression, increase Park2 expression, and decrease expression of α‐synaptonucleoprotein in the pars compactus nigra (SNc). It is found, in vitro study, that Rb3NPs treatment significantly reverses MPTP‐induced apoptosis and death of PC12/SY5Y cells, which is commonly used mouse/ human neural cell lines. It is also found that Rb3NPs@MBs can prevent the production of reactive oxygen species (ROS) in SNc. Finally, it is found that DJ‐1 expression decreases after Rb3NPs@MBs are introduced. Results suggest that the neuroprotective activity of Rb3NPs@MBs may be achieved by increasing the expression of DJ‐1 and decreasing the production of ROS. Taken together, these data reveal that Rb3NPs@MBs play an important role in preventing memory deficiency in PD.

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Pain in Parkinson's disease: new concepts in pathogenesis and treatment

Cited by 68 publications

References 96 publications

Chronic Pain Treatment Strategies in Parkinson’s Disease

Chronic Pain Treatment Strategies in Parkinson’s Disease

New Approaches Based on Non-Invasive Brain Stimulation and Mental Representation Techniques Targeting Pain in Parkinson’s Disease Patients: Two Study Protocols for Two Randomized Controlled Trials

Saponin‐Encapsulated Microbubbles Protect Dopaminergic Neurons from MPTP‐Induced Oxidative Stress Injury

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