Akinetic Crisis And Pain
This type of pain may occur in the advanced stages of Parkinsons. Its brought on by akinetic crisis, which is a rare and sometimes dangerous complication of Parkinson’s.
Akinetic crisis involves a worsening of Parkinsons symptoms, which can include severe rigidity, a complete loss of movement, fever and difficulty swallowing. People with Parkinsons who have akinetic crisis pain say that they feel pain in their muscles and joints, and experience headaches. Some people also experience whole-body pain.
This type of pain can be brought on if you abruptly stop taking Parkinsons medication, or if you develop an infection, both of which can cause Parkinson’s symptoms to suddenly get worse. Akinetic crisis requires urgent medical help. If it looks like someone is experiencing akinetic crisis, call 999.
Q What Is The Role Of Depression In The Pain Experience In Pd
Dr. Fleisher: Depression is one of the most overlooked symptoms of PD, and it can affect over 30% of people with the disease at some point in their illness. I think there is a misconception that depression results from an adjustment disorder following diagnosis. While that may be partially true, patients with PD have alterations in various neurotransmittersincluding serotonin and norepinephrine in addition to dopaminethat predispose them to depression.
Depression is the primary factor related to quality of life in PD and is an independent risk factor for medication nonadherence. A physician could prescribe the most comprehensive regimen to control Parkinsons symptoms, including pain, but if depression symptoms are not being addressed simultaneously, the likelihood that that person is going to take that regimen is pretty minimal.
Given the link between depression and chronic pain, patients who are depressed should be screened for chronic pain and vice versa. In my practice, we screen every patient with the Unified Parkinsons Disease rating scale , which has both a patient-reported subjective component that includes questions about depression, pain, and altered sensation, as well as an objective component that includes a physical examination and questions about potential medication adverse effects . The patient fills out the subjective component every single time they come to the office.
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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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.
Inflammation May Contribute To Both Joint And Nerve Degeneration
byNancy Walsh, Contributing Writer, MedPage Today June 9, 2021
Patients with osteoarthritis are at increased risk for developing Parkinson’s disease, a longitudinal Taiwanese study found.
Incidence rates for developing Parkinson’s disease were 0.99 per 1,000 person-years among patients with osteoarthritis compared with 0.71 per 1,000 for controls, reported Shin-Liang Pan, MD, PhD, and colleagues from the National Taiwan University in Taipei.
Accordingly, the risk among patients with osteoarthritis was 41% higher compared with controls, with an adjusted HR of 1.41 , the researchers wrote online in Arthritis Care & Research.
It is now recognized that inflammation plays a major role in the development of osteoarthritis, while neuroinflammation is characteristic of Parkinson’s disease.
“Because a growing body of literature reports that peripheral inflammation may induce neuroinflammation in the brain, leading to neurodegeneration, we hypothesized that having osteoarthritis may increase people’s risk of later developing Parkinson’s disease,” Pan and colleagues wrote.
Therefore, they analyzed data from Taiwan’s National Health Insurance system, which covers more than 97% of the population, identifying 33,360 individuals ages 50 to 64 who were diagnosed with osteoarthritis during the years 2002 to 2005, matching them by age and sex with the same number of controls.
- Knee or hip osteoarthritis, HR 1.55
- Non-knee or hip, HR 1.42
- Uncategorized, HR 1.32
Disclosures
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Lifestyle Changes For Muscle Atrophy
Along with medication making some positive changes in the lifestyle can be of great help in coping up with the physical limitations in movement. Instead of blaming god and others for the problem, it is better to adapt with the condition and look for ways to improve. One very common problem, which almost all the people suffering from Parkinsons disease face is getting up and sit in the chair. However, having a lifted chair or customizable chair can be of great help to cope with this physical limitation similarly, making a use of physical support tool while walking can help in maintaining balance and avoiding any fall or injury.
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Specific Pain Syndromes In Pd
Orthostatic hypotension can cause headache or neck pain . If necessary, antihypertensive co-medication should be adjusted in accordance with recently given recommendations . Additional measures are physical exercises, fluid intake, wearing of compression stockings class two, and administration of substances such as midodrine, fludrocortisone or, in severe cases, L-threo-3,4-dihydroxyphenylserine . Camptocormia is often accompanied with pain. Prior to therapy the cause has to be differentiated . In addition to the use of pain killers, the focus is on physiotherapy. There is no specific pain medication recommended currently.
Migraine is reported less often in PD, and often associated with depression and sleep disturbances . Therefore the therapy has to focus on the comorbidities as well. The usual medication for migraine can be used, but due to an increased risk for orthostatic hypotension in PD, caution should be exercised with beta blockers .
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Peripheral Neuropathy And Parkinsons Disease
A number of studies have tried to determine if PN is more common among people with PD as opposed to people without PD. PN is a relatively common condition in the general population, which makes it difficult to ascertain whether or not it is even more common among people with PD.
The available studies have varying results and are difficult to compare with each other as they:
- Include different types of populations of people with PD
- Assess peripheral neuropathy differently
- Assess for causes of peripheral neuropathy differently
A recent review looked at all the available data and determined that large fiber neuropathy was present in 16% of patients with PD, about double the prevalence of this condition in the general population. Skin biopsy-proven small fiber neuropathy was present in over 50% of people with PD, although this result was based on a small sample of patients.
Can Parkinsons Be Genetic
According to the researches done so far it has been found that there is a possibility of some form of Parkinsons disease due to genetic mutations. However, the hereditary causes of this disease are quite rare. Around 15% of patients having Parkinsons disease are seen to have a family history of the same. It has been seen that a history of Parkinsons disease running in the family may increase the risk of a person to get it. Having a first-degree family member with Parkinsons essentially raises the risk to 3%. The statistics show that having a parent or sibling with Parkinsons disease may slightly increase the risk.
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Since A Back Injury In 1985 John Has Experienced Multiple Types Of Pain Some Of Which Have Been Triggered By His Parkinson’s He Was Diagnosed With The Condition In 2016
Ive been experiencing varying degrees of pain since injuring my back, which caused me to have lower-back pain, which continues to this day. Since then, I have also developed pain in other parts of my body due to Parkinsons, including my hands, ribs, upper back and shoulder.
The pain in my ribs is deep, aching and constant, and I get internal tremors in this area. However, the pains in my legs are sharp, intermittent and become very rigid, especially in my calves.
When I walk, the pain can get so bad that I end up having to stop and rest. On really bad days, I use a wheelchair. When Im in a lot of pain, it affects my Parkinsons symptoms even more, and also my spatial awareness, that I tend to lose my balance and fall or freeze.
I was referred to a pain specialist…who enrolled me on an 8-week pain management course led by a Parkinson’s-trained physiotherapist. Now I do an hour of gentle movements and stretching every morning.
I cant stand for long enough to wash and have a shave, or to wash the dishes, so I use a perching stool. I can no longer carry out my hobby of canoeing to the same degree. While I use to be able to do it all day, I’m now lucky if I can do it for an hour.
I was referred to a pain specialist, who prescribed me medication, and advised on workable changes to my lifestyle and diet. They also enrolled me on an 8-week pain management course led by a Parkinson’s-trained physiotherapist. Now I do an hour of gentle movements and stretching every morning.
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.
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James* Was Diagnosed With Parkinson’s In 2011 His Pain Has Worsened As His Condition Has Progressed
When I was diagnosed with Parkinson’s, I initially felt little to no pain. It’s only now, in the advanced stages of the condition, that I’ve started feeling pain, coupled with the normal ageing process.
One of the worst pains I experience is dystonia and dyskinesia of the upper body, especially in my neck and head. It usually starts with a pulsing headache, followed by jerking of the muscles in my face, neck, upper torso and hands. It’s particularly severe in my arthritic finger and my neck. It can be severe to mild, often very distressing, and can last up to 2 hours.
I also have mild to moderate, uncontrollable movements or swaying associated with dyskinesia. It’s more prominent when I’m sitting down at a table or working on my laptop. Strangely, I feel this pain at its worst when I’m on the phone, or trying to explain something, or if I’m feeling over-excited or anxious which is when I become severely dyskinetic. There’s now a dull, continuous pain in my neck, caused through the movement, which gets sharper during bouts of the symptom.
I also experience pain when standing, mostly during a ‘wearing off’ period. My knees pull towards each other and the pain is so severe that I can’t walk. Luckily it only lasts a minute or 2, but the pain can be distressing.
To ease the pain, I take paracetamol as and when, occasionally co-codamol, and very occasionally an anti-inflammatory, for the arthritis. I previously tried cannabis oil but it was of no benefit to me.
Stages Of Parkinsons Symptoms
Parkinsons symptoms can be divided into three categories or phases: pre-motor, motor, and cognitive. These phases dont necessarily happen in chronological order, and not all Parkinsons patients will experience all symptoms.
The premotor phase is the phase of Parkinsons in which non-motor symptoms are present. These symptoms include:
There are two main categories of tremor: resting tremor, and action tremor. Resting tremor occurs when muscles are relaxed, like when your hands are sitting in your lap, and lessen during sleep or when the body part is in use. Action tremors occur with the voluntary movements of a muscle.
Tremors typically affect only one side of the body but may affect both sides as the disease progresses. Fatigue, stress, and intense emotion may worsen tremors.
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Fibromyalgia Vs Lupus Differences In Symptoms Pain Causes And Treatment
Fibromyalgia and lupus are two conditions that can cause pain, but its important to recognize the many significant differences between the two. Systemic lupus erythematosus , or lupus, is an autoimmune systemic disorder, which affects the joints, skin, and practically any organ in the body. Fibromyalgia affects the muscles causing pain, tender points, and extreme fatigue, and can contribute to anxiety or depression.
Both lupus and fibromyalgia are difficult to diagnose, and many patients with fibromyalgia are often wrongly diagnosed with lupus and vice versa. Furthermore, the two diseases can actually overlap one another, and there is a higher risk of rheumatic disease in fibromyalgia patients.
Fibromyalgia affects roughly two percent of the population and women are more likely to develop fibromyalgia than men. Estimates of lupus cases in the U.S. are 161,000 with definite lupus and 322,000 with definite or probable lupus. Like fibromyalgia, lupus often affects women more than men, too.
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Q What Is The Pain Experience In Pd And Does It Differ Between Genders
Dr. Fleisher: As with almost everything else in PD, the pain experience is highly individualized, and no 2 people, regardless of gender, will have the same symptoms. Female gender appears to be an independent risk factor for chronic pain in PD, even though PD is more common in men than in women.² Pain intensity also is higher in women than in men with PD.¹
There is a lot of interesting research examining the contributions of hormones to the greater prevalence of PD in men or, conversely, the lower prevalence in women.³ Once we better understand the roles of sex hormones in the pathophysiology of PD, we may better understand whether hormones also play a role in the higher incidence of with PD.
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Pain Due To Fluctuations Dyskinesia Or Dystonia
To reduce potentially pain provoking motor fluctuations and dyskinesias, the optimization of therapy aiming to smoothen dopaminergic plasma level is recommended. The use of prolonged acting dopamine agonists or substances reducing the dopamine degradation such as MAO-B or COMT inhibitors are thought to reduce painful motor fluctuations during day- and night-time as well as early-morning akinesia. PD patients with motor fluctuations, who received the finally not approved partial dopamine D2 agonist Pardoprunox as adjunct therapy to levodopa, showed in a post-hoc analysis of a RCT a greater decrease in VAS pain scores compared to placebo . Amantadine might be helpful for painful dyskinesia, but data is missing.
A second substance with a potential specific effect on pain might be safinamide. In a post-hoc analysis based on pooled data of two large RCTs, safinamide applied as add-on therapy to levodopa treatment was associated with less consumption of pain medication compared to placebo and a significant reduction of pain in two of three sub-items of the PDQ-39 scale reflecting musculoskeletal and neuropathic pain . Noteworthy, in the safinamide group a slightly higher percentage of patients had additional pain medication at study baseline. In summary, this limited benefit needs to be confirmed by dedicated future studies.
Mechanisms That Contribute To Persistent Pain In Pd
As the field progresses psychophysical testing has the potential to advance our understanding of persistent pain in PD by elucidating the mechanisms which underlie pain in PD, and in doing so, identifying subgroups of patients with susceptibility to developing persistent pain while assisting in the development and monitoring of personalised pain management strategies for these patients.
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How Is Pain Treated For People With Parkinsons
No matter the cause, pain is often complex. When a person with Parkinsons experiences intense pain, especially in combination with other symptoms of Parkinsons, managing it can be challenging. There are, however, several ways you can adjust your medication regimen, exercise schedule, and lifestyle to reduce your pain and improve your quality of life.
Medications
There are various kinds of medications used to treat pain, especially for people with Parkinsons. In a recent webinar, Dr. Janis Miyasaki described how physicians approach pharmacological treatment of pain for people with Parkinsons:
The principle is to start with what is called the pain ladder. You always start with the least intensive, least side effect-giving treatment.Janis Miyasaki, MD
Step one
The first step of the pain ladder is hot and cold treatments along with stretching and flexibility exercises. People who experience rigidity and stiffness can sometimes alleviate pain using heating pads to loosen their muscles, then improve mobility by stretching, then address any residual pain with ice packs.
Step two
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