Parkinson Disease: Pain Treatment

Individuals with Parkinson disease (PD) frequently suffer from pain that interferes with their quality of life but may remain under-recognized and inadequately treated, according to a study published online in the Journal of Neurology.

“We found pain to be highly frequent, quality of life-impairing but insufficiently and unsystematically treated,” wrote first author Carsten Buhmann, MD, of the University Medical Center, Hamburg-Eppendorf (Hamburg, Germany) and colleagues.

About three-quarters of patients with PD who participated in the study reported pain that impaired their quality of life. About 10% rated pain as their most distressing symptom.

Individuals with PD can suffer from various types of pain – including musculoskeletal, neuropathic, dystonia-related, akathitic discomfort, and central pain – which can make studying the nature and prevalence of pain in PD challenging. The current study aimed to expand on past studies by evaluating the frequency, location, duration and characteristics of pain in PD. It also looked at the impact of PD therapy on pain, the role of depression and anxiety, and patients’ quality of life.   

The study included 181 individuals seen at the movement disorders outpatient clinic at University Medical Center Hamburg-Eppendorf, Germany. Patients self-reported their pain on four different standardized questionnaires. The researchers also developed their own questionnaire with questions about PD-related pain that were not included on the other questionnaires. Response rates varied by questionnaire, and ranged between 73-94%.

Key Results:

• High prevalence of pain:

♦ Overall: 95.4%

♦ Chronic: 91.1%

♦ Diagnosed pain disorder: 22.3%

• Impaired daily life due to pain:

♦ Overall: 76%

♦ Minor to moderate: 64%

♦ Moderate to severe: 48.4%

♦ Severe to very severe: 30%

♦ Most distressing symptom: 10.2%

• Higher depression and anxiety scores were significantly linked to higher pain levels and higher pain intensity (P<0.125 for both)

• Pain localization:

♦ Back: 71.4%

♦ Joints: 52.4%

♦ Generally not neuropathic: reported by only 15.3%

• Most commonly treated by orthopedists, general practitioners, and physiotherapists: (62%, 50.0%, 61.3%, respectively)

♦ Not commonly treated by neurologists (3.3%) or pain specialists (10.9%)

• Most effective therapies:

♦ Rehabilitative therapy: 96.3%

♦ Physiotherapy: 89.5%

♦ Pain killers: 77.9%

♦ Only 33.6% found relief from anti-PD drugs

The authors noted that NSAIDs were the most common form of analgesics, and were used by 60% of participants. While respondents rated rehabilitative therapy as the most effective treatment, only 22% received this type of treatment. The results may point to the need for an expanded role for inter-disciplinary rehabilitative therapy in PD patients, according to the authors.

Over half of patients treated for pain reported limited duration of therapeutic effect, and there was no standardized treatment concept. 

While only one-third of patients reported anti-PD medication as effective, respondents also reported that pain was more frequent during the morning and evening, perhaps related to painful “off” periods in the morning and wearing off effects in the evening. The authors advised optimizing anti-PD medication to relieve musculoskeletal pain-related motor fluctuations or rigidity.

They also highlighted the low percentage of neurologists who treated pain in PD, implying that “neurologists as the main treating physicians of PD patients in fact overlook or underestimate pain in PD.”

Take-home Points

• A single center German study found pain that impairs the quality of life is frequent and may be inadequately treated in PD.

• Depression and anxiety were linked to higher levels of pain.

• Rehabilitative therapy was rated as most effective, though only 22% of patients received it, pointing to the need for an expanded role for rehabilitative therapy in treating PD-related pain.

• Only 3.3% of neurologists treated PD-related pain, suggesting that main treating physicians in PD may overlook their patients’ pain.

The authors report no conflicts of interest.

Reference: Buhmann C, et al. Pain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy. J Neurol. 2017 Feb 27.