Q Is There Anything Else You Would Like To Tell Our Readers
Dr. Fleisher:There are so many symptoms of PD that it can be easy to overlook pain symptoms if a patient doesnt report them. Remember that pain may be a really prominent symptom for patients, but, given that we have only learned how pain is connected to PD in the past 20 years, patients may not be aware of the association and may not bring up pain symptoms with their neurologist.
Thus, the burden is on us to ask about pain, particularly if the patient is depressed. If a patient with PD has both pain and depression, both of those comorbidities should be targeted, because it can be hard to achieve successful outcomes for either pain or depression if one is treated without the other.
Incidence And Prevalence Of Pd General Pain And Pd
Estimates of PD prevalence and incidence have provided conflicting estimates. In Europe, the annual incidence estimates range from 5/100,000 to 346/100,000. Approximately 60,000 Americans are diagnosed with PD each year. The challenges involved with differential diagnoses and other forms of Parkinsonism, as well as the long time course from initial PD-like symptoms to a correct diagnosis, are likely responsible for the discrepancy in numbers.
The reported prevalence of pain in PD and PD-related pain also varies between studies. In 2008, Negre-Pages et al estimated the prevalence of chronic pain in PD to be > 60%. PD pain is often reported as heterogeneous in its clinical presentation, with a disabling effect on quality of life assessments. In 1998, the Swedish Parkinson Association reported on a survey of nonmotor symptoms comprising almost 1,000 PD respondents, revealing that pain was more common in females than males . However, general pain is also common in the population, with 18%19% in a general adult population according to the prevalence data.,
In early-stage PD, pain is rated as one of the most troublesome NMS, and it seems to affect the side of the body that was initially worst impacted by motor symptoms of the disease .
Pain In Parkinsons Disease: A Spotlight On Women
Chronic pain occurs in 30% to 85% of patients with Parkinsons disease , particularly in women, and is one of the strongest predictors of poor quality of life in patients with this disease.1,2 Dr. Fleisher responds to questions that offer clinicians insights into the pain experienced by women who have Parkinson’s disease.
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Examples Of Pain Scales In Pd
Pain-O-Meter
This is a self-administered pain assessment tool developed for the purpose of improving pain assessment and management in acute and chronic pain patients, not exclusively for PD pain. It is a hard, white, plastic tool. Two methods for assessing pain are located on the Pain-O-Meter . The first is a 10-cm VAS with a moveable marker that patients use to rate their pain. The second is a list of 15 sensory and eleven affective WDSs. Each WDS is assigned an intensity value that can be as low as 1 or as high as 5 .
| Durationa of disease, 5 years/> 5 years | Pain before/after PD diagnosis | Durationb of pain/day, 10 h/> 10 h | VAS,c5 cm/> 5 cm | Pain expressions by participants |
|---|
Notes: POM results for PD and chronic pain patients. Data from Skogar et al.
P
Abbreviations: PD, Parkinsons disease h, hours VAS, visual analog scale RLS, restless legs syndrome POM, Pain-O-Meter.
Kings PD Pain Scale
Causes Of Lower Back Pain
People with PD may have the same lower back issues that affect the general population.
Here is a picture of the spine and its surrounding structures.
There are specific structural problems of the lower spine that can lead to pain. Primarily the structural problems fall into two categories:
- Narrowing of the central spinal canal through which the spinal cord travels. This can cause spinal stenosis and typically manifests as pain with standing or walking that improves with bending forward or sitting.
- Narrowing of the exit holes through which the spinal nerves travel. This can cause what is known as radiculopathy, pinched nerve, or sciatica and typically manifests as pain that travels down a leg.
There are many causes of these narrowings including:
Much less common, are infections of the spine or cancers growing around the spine. Both of these conditions can push on the spine or spinal nerves and cause pain.
Surprisingly, all of these causes together typically account for a small percentage of lower back pain. For most people with lower back pain, no specific structural cause can be identified.
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Paw Prints: Furry Friends Help My Sister Do Life With Pd
Bev said, I love seeing the trees, feeling the breeze on a summer day, sitting in front of the pond, and listening to the birds sing.
Parkinsons News Today columnist Dr. C wrote that gardening helps him manage his PD because of all the health benefits.
A 2019 article published in the journal Scientific Reports shared the benefits of spending time in an outdoor setting.
Journalist Jim Robbins summarized the findings of this study in his 2020 article about the benefits of nature for Yale Environment 360. He wrote, people who spent two hours a week in green spaces local parks or other natural environments, either all at once or spaced over several visits were substantially more likely to report good health and psychological well-being than those who dont.
Not everyone with PD may be able to spend two hours a week in nature, but the Davis Phinney Foundation for Parkinsons notes that everyone can do something. An article on the organizations website includes the following suggestions.
Pain Shows Up As Parkinson’s Sets In
Study Shows Pain Is Felt at Onset of Parkinson’s Disease
New research shows that another thing to look for as Parkinson’s takes hold is pain.
The study, led by Giovanni Defazio, MD, of the University of Bari, shows that people with Parkinson’s have more pain than those who are disease-free.
Researchers found that the pain seems to show up with the onset of the disease or shortly thereafter.
The research team looked at 402 patients who had Parkinson’s disease, comparing them to 317 people who did not have the disorder.
The groups were similar in ages and the proportion of men and women.
However, more Parkinson’s participants had depression and medical conditions associated with pain symptoms, such as diabetes and herniated discs.
Taking into account age, sex, depression, and other medical conditions associated with pain, 70% of the Parkinson’s patients said they experienced pain lasting at least three months, compared with 63% of the comparison group.
The type of pain that the Parkinson’s patients most reported was related to “dystonia” — involuntary muscle contractions.
Among the Parkinson’s patients, 17% had dystonia. Dystonic pain was more commonly located in the leg, foot, neck, or shoulders.
When it came to pain that was nondystonic, rates were similar between Parkinson patients and the comparison group.
The average age for the onset of Parkinson’s disease was 60.
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Second Type Of Leg Pain Is Caused By Dystonia
When related to levodopa, it usually occurs as a wearing off but can also occur at peak dose. In most cases this leg pain is unilateral and has direct correlation to medication intake. When pain is due to dystonia, it is more common in early morning. This type of leg pain is usually accompanied by toes curling and foot abnormally posturing.
Pain In Parkinsons Disease
Parkinsons patients suffer from the same pain other people have, often amplified by the motor dysfunction, but they also have additional pain problems unique to PD. Lower back pain and back of he neck pain are most common. Strengthening exercises or stretching may be helpful. Identifying the cause of the pain is essential in treating the pain. Treatments include physical therapy, medications, and alternative therapies like Reiki, acupuncture and massage.
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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
Im In Pain But I Dont Want To Take Carbidopa/levodopa Yet Because My Doctor Says It Will Only Work For Five Years Any Advice
It is true that as time passes and your disease progresses, you will have to take higher doses to replace the dopamine your body can no longer produce. However, the rate of dopamine loss is different for everyone. What your doctor may be telling you is that after taking carbidopa/levodopa for some time, you may begin to experience side effects like dyskinesia. It is important to understand that while you may experience this unwanted side effect, for example, you still benefit from the carbidopa/levodopa. If you believe your pain is Parkinsons-related, and you have already tried other medications and complementary therapies without relief, it is probably time to try carbidopa/levodopa.
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Functional Exercise For Chronic/persistent Pain
There are some simple exercises that you can try around the house to help:
- If you experience pain in your legs, keep them strong by practising standing up and sitting down in a chair.
- If your shoulders are aching, start by loosening them with some shoulder rolling actions, then by lifting an object that is slightly weighty from a shelf, and then replacing it. This increases the range of movement in your back, shoulders and arms, and then your strength.
Q Are There Any Alternative Therapies That Are Effective For Pain In Pd
Dr. Fleisher: Although alternative therapies may be helpful, there is little evidence-based research to support their use. Certainly massage therapy, anecdotally, seems to be helpful for managing pain. Small studies suggest that acupuncture might improve sleep in patients with PD, but data on the effects on pain in PD is lacking. Larger, more well-controlled and reproducible studies of these therapies are needed.
Patients frequently ask about the effects of medical marijuana in managing PD, including pain symptoms. Several studies have looked at efficacy of marijuana in PD and have found that it probably is ineffective for most PD symptoms.11 However, we just dont have enough evidence to know for sure. The most rigorous study of medical marijuana in PD showed a trend toward worsening tremor.11,12
For most people, stress and anxiety worsen tremor, and anything that relieves anxiety will improve tremor. Thus, modalities such as yoga, meditation, and mindfulness training will improve tremor. Similarly, medical marijuana may improve tremor in certain people by temporarily reducing anxiety and stress, but the evidence has not borne this out yet.
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Mental Status And Social Networks
As previously mentioned, depression and pain are significant clinical problems that are comorbid with PD. Marital status, as well as other social networks, interferes with these conditions. The patientspouse relationship, which indicates physical and emotional support, may have a mitigating effect on patient outcomes of depression prevalence and pain interference. Single PD patients seem to have greater pain interference scores than cohabiting PD patients.
Hand And Finger Stimulation Exercises
I have done a lot of hand/finger stimulation and experimented to optimize such exercises, in the spirit of Curiosity and Play. I’ve personally found significant benefit in pursuing this line of research. Indeed, I have managed to recover a lot of my independence and quality of life through hand and finger therapy, and I know just how much of a major part it has played in my own progressive symptom reduction.
I therefore encourage everyone with PD to do as much hand and finger stimulation as possible, through games and play and self-discovery. By doing nothing, the only thing that will happen is that out situation will rapidly become worse, because we will lose the use of our hands quicker and consign ourselves to increased suffering. By applying neuroplasticity techniques , we can delay the worse ravishes of the disease or even, like in my own case, continuously push the symptoms back and recover some independence. I feel this is an important message for those newly diagnosed, in particular.
Here are some suggestions of the type of stimulatory exercises and games which can help, more ideas which I have personally found beneficial will be provided in forthcoming articles.
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Dont give up.
At times, not giving up is easier said than done, especially when you feel alone and abandoned. You may feel your friends and family have abandoned you, but its often more a case of them not understanding your new journey. Its probably best to give those people in your life a free forgiveness pass and move on as you make new friends in the PD community who truly understand what living with PD is like.
Parkinsons disease causes grief, but we can choose to live joyfully and intentionally in spite of what we feel has been taken from us. It is not a death sentence, and we must learn to readjust to our new life. And a new life brings new opportunities. As one person said, never lose hope and keep the faith because God is doing miracles every day and you may be the one He is working through to accomplish just that.
Natural Remedies And Treatments For Parkinsons Finalnote
So there you have our top 10 natural remedies andtreatments for reversing Parkinsons disease. We believe this is one of the most informative andthorough health articles on this disease youll find anywhere on the internet. Ifyou follow these 10 tips to-the-letter and continue to use them consistently,we guarantee that in 3-6 months time you will be truly astounded at themiraculous level of improvement youll see. In 12 months time you will scarcely recognize yourself! . But of course, you must stickwith them and follow through with each remedy every day if you want them towork. We sincerely hope you do.
Good luck and best wishes.
P.S. Because Parkinsons is closely linked to Alzheimers disease and actually goes under the dementia umbrella, we recommend you take the time to read our Powerful Natural Remedies for Dementia and Alzheimers article for a more complete and comprehensive understanding on the causes and treatments for these diseases. You can click on the link below to go there
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All Up A Multidisciplinary Team Approach For Pain Management May Be Necessary In Addition To Your Movement Disorder Specialist Providers May Include Physical Or Occupational Therapists Psychiatrists And Even Pain Management Experts Each Of These Practitioners Targets A Different Aspect Of The Pain
Exercise to Relieve your Pain
Many different types of exercise can be beneficial for people with Parkinsons disease , including non-contact boxing, tai chi, dancing and cycling, as some examples. If you have limited mobility, you can try chair yoga or other seated exercises. Whichever exercise you choose, make sure it is something safe and enjoyable so that you can stick with it.
Its important to pace yourself and know your personal limitations. If during or after exercise you experience extreme pain you should look at modifying your routine and choose a less intensive exercise. Even the simplest exercise, including walking your dog or just puttering around the house or garden, can help alleviate symptoms of pain.
- Cycling
If you need help or advise consult with a physical or occupational therapist to help design a personalised program for you. Learn more about exercise and Parkinsons.
Non-pharmacological pain treatments
Complementary therapies are treatments used alongside conventional medicine. They take a more holistic approach than conventional medicine, aiming to treat the whole person including mind, body and spirit, rather than just the symptoms. These include massage therapy, mindfulness and meditation techniques, acupuncture, and heat or cold application. These may be used on their own or in combination with medication.
Anti Inflammatories
Pain In Restless Legs Syndrome And Pd
PD patients who receive increasing dopaminergic doses over their disease course could show an increased prevalence of restless legs syndrome . First, for the treatment of painful RLS, the compensation of iron deficiency, defined as an iron storage value of less than 5075g/l, is recommended . Iron should be applied preferentially intravenously, because efficacy of oral application has not been adequately evaluated and iron given orally can deteriorate constipation and interacts gastrointestinally with levodopa and COMT inhibitors . Of note, drugs that potentially reinforce RLS such as mirtazapine, SSRI or neuroleptics, should be discontinued.
In general, painful RLS in PD should be treated according to the guidelines for idiopathic RLS recommending low-dose dopamine agonists before night-time as first choice treatment, gabapentine and pregabaline as second line options, and oycodone/naloxone as escalation therapy . In PD, the non-ergoline derivates pramipexole, ropinirole and rotigotine should be preferentially used. Because rotigotine has shown positive effects on PD-associated pain beyond the RLS, it might be preferentially used in painful RLS in PD patients .
Carbamazepine and valproic acid were considered likely efficacious in idiopathic RLS but are not suggested in PD due to potential side effects.
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