Pains in Parkinson disease—many syndromes under one umbrella

Abstract

Pain is a nonmotor symptom that substantially affects the quality of life of at least one-third of patients with Parkinson disease (PD). Interestingly, patients with PD frequently report different types of pain, and a successful approach to distinguish between these pains is required so that effective treatment strategies can be established. Differences between these pains are attributable to varying peripheral pain mechanisms, the role of motor symptoms in causing or amplifying pain, and the role of PD pathophysiology in pain processing. In this Review, we propose a four-tier taxonomy to improve classification of pain in PD. This taxonomy assigns nociceptive, neuropathic and miscellaneous pains to distinct categories, as well as further characterization into subcategories. Currently, treatment of pain in PD is based on empirical data only, owing to a lack of controlled studies. The facultative symptom of 'dopaminergically maintained pain' refers to pain that benefits from antiparkinson medication. Here, we also present additional pharmacological and nonpharmacological treatment approaches, which can be targeted to a specific pain following classification using our taxonomy.

A Review of Pain Prevalence in Alzheimer's, Vascular, Frontotemporal and Lewy Body Dementias

“…This lack of studies could be explained by several epidemiological factors; for instance, FTD is relatively more prevalent in a younger population, whereas pain is more prevalent in the older population [4]. A specific reason for the lack of studies in DLB could be that these patients may be studied within trials assessing pain in PD, as Lewy body neuropathology is a key feature of PD and prevalence of pain in PD is estimated to be between 40 and 60% [34,35]. Furthermore, we found that the methods of pain assessment varied widely, and many of the used instruments were not specifically designed for the population, for example the EQ-5D, which is an instrument to measure quality of life and only incorporates one pain item.…”

Pain characterization in patients with Parkinson’s disease

“…PD patients have two different types of pain: nociceptive and neuropathic. Nociceptive pain is extremely frequent (40-90%) 27 and is typically musculoskeletal and visceral. Musculoskeletal pain is in general caused by abnormal posture, rigidity and akinesia causing motor fluctuations.…”

“…Pain has been more deeply studied in recent years as a PD symptom which substantially affects QL of at least one third of patients 11 . Considering our results, mean age of studied population and presence of pain, there has been no correlation, similarly to literature reports [12][13][14] .…”

Mechanisms of α‐Synuclein Pathology and Treatment in the Enteric Nervous System

“…Despite its prevalence in Lewy Body patients [46,47] and debilitating impact on quality of life, gastric immotility is rarely a focus of treatment for patients with PD and NCDLB [4,34,36,39,[53][54][55][56]. When PD and NCDLB constipation is addressed, primary care physicians typically recommend conventional (often overthe-counter) treatments, despite data demonstrating that such treatments are ineffective with this population [54].…”

“…Escalating gastric immotility in PD and NCDLB can interfere with mobility, sleep, cognition, and mood, increasing the cost of care, and potentially debilitating and/or dramatically reducing the quality of life for patients. [4,34,36,[53][54][55][56] …”