What Kinds Of Pain Can Be Part Of Parkinsons
At its simplest, pain means the body hurts. When a person feels pain, nerves in the skin, joints and organs alert the brain to the location of an injury. Researchers have found that in early PD, there are already changes in the way that the body detects and regulates pain. Pain is complex and can take many forms. In PD, pain tends to affect the side of the body where motor symptoms first appeared. If your PD started with a tremor in the right hand, youre more likely to develop pain in the right shoulder, wrist or fingers. Here are a few common types.
Musculoskeletal pain
Musculoskeletal pain is experienced by up to 75 percent of people with PD and includes pain in the muscles, bones or skeleton. It is related to rigidity and decreased movement, and to arthritis. Many people with PD experience muscle cramps and tightness in the neck, spine and arms. Muscles may feel stiff or achy. Joint pain, especially in one shoulder, is also common. Its not uncommon for people with PD to be diagnosed with frozen shoulder or rotator cuff problems, and even undergo surgery.
Dystonic pain
Neuropathic pain
Central pain
Central pain affects about 10 percent of people with PD at some point. It can be difficult to describe but may include a vague, constant boring sensation abdominal pain, reflux, shortness of breath or feeling flushed painful sensations around the mouth, genital or rectal areas or simply pain all over.
Parkinsons And Foot Care From The Parkinsonian
WHAT FOOT PROBLEMS CAN PEOPLE WITH PARKINSONS EXPERIENCE?
There are a number of general foot problems, such as corns,bunions and verrucae, that can affect everyone, regardlessof whether they have Parkinsons or not. But there areother difficulties people may experience because of theirParkinsons symptoms.
DYSTONIA AND TOE-CURLING
People with Parkinsons may experience muscle cramps anddystonia in their feet. This is where one of your muscles or agroup of muscles tighten or shorten involuntarily.Sometimes this may cause the toes to curl in, in a claw-like way.Occasionally, the ankle may also turn inwards and put pressure on the outside of the foot. There mayalso be hyperextension of the big toe, which causes it to stickup and rub on the shoe. This can lead to pressure problems onareas of the foot that are not meant to deal with such pressure.In some cases, dystonia can be connected to your Parkinsonsmedication speak to your specialist or Parkinsons CommunityEducator to see if changing your dosage helps. A podiatrist canalso advise you on suitable treatments for toe-curling.Dystonia can also affect the Achilles tendon at the back of theheel, causing it to tighten up and pull the foot in a downwardposition. This is another possible cause of toe-walking.
SWELLING
WHAT CAN I DO TO HELP MYSELF?
TOE SPLINTS
GENERAL FOOT CARE TIPS
Treatment Depends On Properly Identifying The Type
If pain is bilateral always assume it is central pain pain due to PD. In my experience Azilect works great for this type of pain. Other medications which can be employed for this pain as well.
Massage therapy works for all types of leg pain-my favorite therapy but can be costly. Water therapy may also work for all types except central pain. Physical therapy can alleviate dystonia pain, as well as musculoskeletal and radicular pain.
If pain is due to dystonia related to levodopa intake, find out when it occursend of dose or at peak dose. Typically adjusting medication doses will resolve problem. However, if dystonia is an initial symptom of PD, initiating treatment with levodopa will resolve. If medication adjustment does not work well for levodopa induced dystonia, another treatment option is DBS . Pain due to dystonia independent of cause can also respond well to Botox injections, as well as centrally acting muscle relaxants. To avoid and alleviate pain caused by stiff muscles, a great treatment option is activity in the form of stretching exercisesany number of activities will do such as tai-chi or yoga. For me when I start having radicular pain shooting down my leg it is time to up my levodopa dosage.
If you are having leg pain make sure to discuss it with your physician.
Read Also: Amino Acids And Parkinsons
Read Also: How To Diagnose Parkinson’s Disease Symptoms
Pain Presentation And Assessment In Pd
Most epidemiological data are based on questionnaires which were not specifically validated for PD patients so that results have to be interpreted with caution. The Kings Parkinsons disease pain scale is to date the only questionnaire that is specifically calibrated and validated for PD and is highly recommended to qualitatively and quantitatively assess pain and to ascribe the pain pathophysiologically. The scale contains seven different pain domains comprising musculoskeletal pain, chronic pain , fluctuation-related pain, nocturnal pain, oro-facial pain, discolouration or oedema/swelling and radicular pain as well as 14 sub-categories . This assessment tool is based on the pain classification according to Ford but also considers pain types of other classifications such as motor fluctuations or visceral pain .
In addition, there are some specific pain syndromes in PD which have to be kept in mind, including the so-called coat-hanger pain that occurs in cases of pronounced orthostatic dysregulation and although it is more frequent in multisystem atrophy it can occur also in PD and is often associated with strong headache and neck pain . Furthermore, pain due to constipation which is frequent in PD can cause abdominal pain.
Acpa And Stanford Resource Guide To Chronic Pain Management
This 213-page downloadable PDF is a comprehensive, integrated guide to medical, interventional, psychological/behavioral, pharmacologic, rehabilitative, complementary and integrative, and self-help strategies in the treatment of chronic pain. It covers general information compiled from multiple sources, is updated yearly and includes imbedded web links for certain medications and treatments and relevant internet sites of interest.
This questionnaire can help identify type of pain and determine whether someone should see a pain specialist.
Recommended Reading: Ritalin For Parkinsons Disease
You May Like: Best Walking Cane For Parkinson’s
Considerations For The Inpatient Management Of Parkinsons Disease
Recognising and managing certain complications of Parkinsons disease can help improve care and reduce the risk of admission for people living with the condition.
Degenerative neurological disorders
Sergio Azenha / Alamy Stock Photo
Parkinsons disease is a neurological disorder in which there is progressive death of dopaminergic neurones in the substantia nigra the part of the mid-brain responsible for managing movement and the dopaminergic system with more than 50% of cell death occurring before symptom manifestation. The subsequent deficiency of dopamine synthesis, owing to this cell death, leads to the progression of motor symptoms including bradykinesia, rigidity, tremor and postural instability,.
Around 137,000 people in the UK have a PD diagnosis. The cause of the disease is yet to be discovered, but a combination of environmental and genetic factors are thought to increase its risk. Despite this, there is a lack of robust, large-scale evidence of a definitive link between any specific environmental risk factors. Around 20% of patients affected by PD have a first-degree relative that is affected by the disease. Prevalence is higher with increasing age and men appear to be at higher risk of developing the disease than women,. Patients with PD have a reduced life expectancy and studies have suggested up to a five-times higher mortality rate than people in the same age group without PD.
Also Check: 5 Signs You Ll Get Parkinsons
Long Term Risks Longer Than 3
- Overall, Exablate Neuro is a reasonably safe procedure for treating essential tremor with minimal risk. Infrequent complications that have been reported following Exablate Neuro treatment include long-term numbness and tingling. Additionally, if brain tissue is damaged, there may be muscle weakness, numbness, or sensory loss that may resolve after several months, or it may be non-reversible.
Also Check: Foods To Prevent Parkinson’s Disease
Foot Cramps And Spasms
Foot cramps or spasms can occur suddenly and with no known cause. Some common theories as to why they occur include abnormal levels of minerals or electrolytes in the body, dehydration, kidney disease, thyroid disorders, certain medicines, and brain disorders such as Parkinsons disease, multiple sclerosis and dystonia. Muscle fatigue in the feet, numbness and tingling, twitching, rapid motions and tightening of the muscles are all common symptoms and can range in severity. Most cramps or spasms are temporary and will go away on their own with rest, stretching and hydrating. If these episodes continue to occur frequently, then a doctor should be contacted to test for a possible disorder or deficiency.
You May Like: Does Parkinson Run In Families
Management Of Pain In Parkinsons Disease
Issue title: Special Issue: Clinical management of Parkinsons disease: Essentials and new developments
Guest editors: Bastiaan R. Bloem and Patrik Brundin
Article type: Review Article
Authors: Buhmann, Carstena* | Kassubek, Janb | Jost, Wolfgang H.c
Affiliations: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | Department of Neurology, University of Ulm, Ulm, Germany | Parkinson-Klinik Ortenau, Wolfach, Germany
Correspondence: Correspondence to: Prof. Dr. Carsten Buhmann, Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 52771 Fax: +49 40 7410 45780 E-mail: .
Keywords: Parkinsons disease, pain, therapy, analgetics, pathophysiology, non-motor symptoms
DOI: 10.3233/JPD-202069
Journal: Journal of Parkinsons Disease, vol. 10, no. s1, pp. S37-S48, 2020
Abstract
Seated Option: Fingers Between Toes
*Cant get into the figure-4 position or reach your feet? Check out the Yoga Toes a helpful toe-stretching tool.
You May Like: Causes For Parkinson’s Disease
These Treatments And Interventions May Help
Interventions tend to be most successful in the earlier stages, so you should bring your symptoms to your doctors attention as you notice that youre having trouble flexing the joints of your toes, says the Cleveland Clinic.
Several treatment options may be available, which you can utilize in addition to pain management or anti-inflammatory medication, explains Scudday. For more extreme or painful cases that do not respond to conservative treatment, surgery may be recommended as an option. Both hammertoe and claw toe can be surgically reconstructed and realigned into proper position or the entire toe joint can be replaced, says the podiatrist. The patient may also consider wearing different shoes, padding their shoes, wearing arch support inserts, or practicing toe-strengthening exercises as a form of physical therapy.
And, of course, be sure to speak with your doctor about the underlying cause for the changes in your toes. If a neurological disease such as Parkinsons is responsible, timely intervention for that condition may significantly improve your quality of life.
Seated Option: Calf Stretch with Strap
Improve Your General Fitness
Increasing your level of fitness will help you manage your weight and ensure your joints arent under any added pressure. You could try walking, swimming, dancing, cycling or aerobics its up to you.
Many of Parkinsons UKs local groups have physiotherapist-led exercise classes you can join. Visit our Local Support page or call our helpline on 0808 800 0303 to find one near you.
Recommended Reading: Foods To Help With Parkinson’s Disease
Identify The Cause Of The Pain
The first step in treating pain is to try to identify the cause. As I noted in the last essay, there are many different causes of pain for people with PD. If we look at the most common pain problems, low back and neck pain, we can see that there are many different causes for each. Many doctors order x-rays of the spine for these conditions, and they may be needed. The main problem with x-rays of the spine is that they always show arthritis, which is because virtually everyone over the age of 60 has arthritis in the spine. Whether thats the cause of the pain or not is usually not clear.
However, x-rays will show if theres a compression fracture , or a tumor. Since older women frequently develop compression fractures even without a fall, this can be important because we know then that the pain is likely severe, but time limited, and will resolve in a month or two. This makes it easier to treat with strong medication, like narcotics, because there is less concern for addiction. X-rays do not show discs, but disc herniation is much less common in older people so its of less concern.
Physical Therapy
Alternative treatments
Chiropractors focus entirely on spine pain and may be very helpful. Since many medical doctors are not very familiar with PD, I assume that many chiropractors probably arent either. Therefore it will be helpful to find one who is familiar with PD. Probably the best way to do this is through a Parkinsons Disease support group in your area.
Photo credit: Morgan
The Use Of Levodopa And Peripheral Neuropathy
There are reports in the literature that levodopa use may increase the risk of peripheral neuropathy, although other studies suggest that this is not the case. There are studies that demonstrate for example, that cumulative Levodopa exposure correlates to prevalence of PN in people with PD. Other studies however, demonstrate no difference in the prevalence of PN whether the person was treated with Levodopa or not, suggesting that Levodopa treatment does not play a role in development of PN.
Another area of research that emerges from the literature is the potential role of Vitamin B12 deficiency in the development of PN in those with PD. Some studies suggest that Vitamin B12 deficiency is a more common cause of PN among those with PD than those with PN who do not have PD.
There is also research that suggests that levodopa treatment may contribute to PN through impairment of Vitamin B12 metabolism, leading to Vitamin B12 deficiency. Taking COMT inhibitors such as Entacapone may protect against this complication.
Regardless, if PN is diagnosed in anyone, whether they have PD or not, and whether they take Levodopa or not, Vitamin B12 and various other markers of Vitamin B12 metabolism should be tested. If Vitamin B12 levels are low or even low-normal, a person should take Vitamin B12 supplementation, which may help with the symptoms of PN. Other causes of PN, many of which can be checked with various blood tests, should be investigated as well.
Read Also: Parkinson’s And Gut Health
Not Your Usual Neck And Back Pain
There are many ways to get a backache. This is new for me lower back pain that leads to spasms and literally drives me to my knees.
It doesnt feel like the pain from overdoing it in the garden. Every gardener knows that exquisite twinge from too much lifting or shoveling. After all the years I have gardened, I know that pain well. This is not my usual lower back pain.
An article published in 2018 in the European Spine Journal found significantly more cases of low back pain, with longer durations, in patients with Parkinsons disease than in healthy controls. Parkinsons patients also experience more frequent and intense lumbar pain. Researchers concluded that Parkinsons progression can lead to degeneration of the lumbar spine, and this leads to low back pain for about 88% of this population.
Recommended Reading: Parkinsons Loss Of Appetite
Contraindicated Drugs For Parkinsons Patients
More than two dozen drugs should not be taken by Parkinsons patients because they alter the brains dopamine system. Always let your neurologist know before you have surgery, so he or she can work with your medical team to keep your Parkinsons in control. View a list of drugs that Parkinsons patients should not take.
You May Like: Parkinson Disease Medications To Avoid
Read Also: Is Thumb Twitching A Sign Of Parkinson’s
/4in Parkinsons An Individuals Movement Slows Down
Parkinsons disease is a disorder of the nervous system that affects the movement of an individual. In this disorder the dopamine producing neurons of the brain are affected. When dopamine levels decrease in the brain, abnormal brain activity, leading to impaired movement is seen in an individual and this is one of the major symptoms of Parkinsons disease.
Dont Miss: Exercise For Freezing In Parkinsons
Types Of Parkinsons Pain
Most of the time, discomfort in muscles and joints is secondary to the motor features of Parkinsons lack of spontaneous movement, rigidity, and abnormalities of posture what is known as musculoskeletal pain. The most commonly painful sites are the back, legs, and shoulders and it is usually more predominant on the side more affected by parkinsonism.
But there are many other categories of pain associated with Parkinsons disease. Radicular or neuropathic pain is experienced as a sharp pain that can start in the neck or lower back with radiation to arm or leg respectively and is often associated with numbness or tingling, or a sensation of coolness in the affected limb. It is usually secondary to a pinched nerve due to something like a slipped disc.
Dystonia related pain occurs as its name suggests, at times of dystonia most often experienced in the foot, neck or face and arm at different points in the dosing schedule, particularly the off phase when there is not enough dopamine replacement but can uncommonly also occur at peak-dose times. It can be one of the most painful symptoms those with Parkinsons can face.
Akathisia pain is experienced as restlessness, a subjective inner urge to move, an inability to stay still and the inherent feelings of discomfort that it brings. It is primarily experienced in the lower limbs and can often be relieved by walking around.
Read Also: Is Parkinsons A Form Of Cancer
You May Like: If My Father Has Parkinson’s Will I Get It