How Do Methamphetamines Cause Parkinsons Disease
Parkinsons disease is caused by the death of a region of the nervous system known as the substantia nigra. This part of the brain both produces and releases the neurotransmitter dopamine. Since dopamine is so closely tied with the primary functions of the nervous system as they relate to coordination and movement, a permanent dopamine deficiency can lead to the same progressive and chronic symptoms that characterize Parkinsons disease.
Researchers have long known from non-human animal studies that methamphetamine induces cell death within the substantia nigra, though only recently have studies been able to verify the correlation to any large degree. One of the animal studies conducted in the mid-1990s indicated a total reduction in dopamine within the substantia nigra in laboratory mice of 40-45 percent within one week of exposure to methamphetamine.
A similar study on mice demonstrated that just three dose-proportioned methamphetamine injections set at three-hour intervals produced a fairly immediate reduction in dopaminergic cells of between 20 and 25 percent.
Observable significant increases in microglial cells, designed to protect the nervous system, are seen within the substantia nigra within hours after methamphetamine exposure, indicating some level of neurotoxicity.
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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 Treatment Is Available
For treatment to be effective, it is essential to understand the trigger or cause of the dystonia. Certain medications may be effective for some people but not for others. Some work by interfering with neurotransmitters in the brain and disrupting the messages they send to muscles. Others work by relaxing the muscles to reduce shaking and improve muscle control.
Depending on the cause and severity of your dystonia, your doctor may suggest the following strategies:
Remember that not all of these strategies will work for everyone so it is important to communicate well with your doctor so that, together, you can find the best solution for you.
Keeping a diary: If the dystonia is levodopa-related, it is a good idea to keep a ‘motor diary’ to record when dystonic spasms occur and how they relate to the timing of medications. This information can help your doctor adjust dosage and/or timings of medication to better manage your dystonia. For more information, see Keeping a diary.
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 occurs—end 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 exercises—any 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.
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Pain In Parkinsons Disease: A Spotlight On Women
This 2-page interview with neurologist, Dr. Jori E. Fleisher, discusses pain in Parkinsons disease with some interesting statistics about women and pain. Dr. Fleisher outlines the 4 primary types of pain in PD, how depression interferes with pain management, the role of exercise and medications in pain management as well as alternative therapies.
Exercise Stretch And Strengthen
- Even if you dont feel like it, exercising every day can increase flexibility in your muscles and joints, reduce pain and discomfort, and improve circulation. Exercise can increase the secretion of your happy hormones, improve your mood, and decrease anxiety and depression.
- If you have discomfort in your calves, ankles, feet, or toes, and try the eight exercises physical therapist Sarah King recommends.
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Revisiting Pain In Pdthe 50 Shades Of Pain Experienced By Parkinsons Patients
Pain is a quality of life issue for people with Parkinsons disease and can be under treated by doctors who may assume that is worsens as the disease progresses, although for some pain is an initial symptom of PD. This article helps focus your physicians attention in the right direction to accurately diagnose your pain.
Adverse Health Effects Of Methamphetamines
In addition to dopamine cell death, abuse of methamphetamine, a nervous system stimulant, can also lead to memory loss and cardiovascular damage, as well as psychotic behaviors, social isolation, aggravation or aggression, and mood disorders including anxiety, depression, and paranoia.
Someone who is abusing methamphetamine is also likely to experience an increase in both respiration and heart rate, irregular heartbeats, a significant reduction in appetite, and severe insomnia. Methamphetamine abuse can also lead to a feeling skin crawling, in which someone feels compelled to scratch or pick at their skin. Hair loss and tooth decay are also common with long-term use of methamphetamine, as is malnutrition from changes in diet.
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Fourth Type Of Leg Pain Is Radicular Pain
In this case, the pain is caused by compression of nerves in lumbar area which results in weakness, numbness and tingling, and loss of reflexes from buttocks to foot in a distribution of a nerve. It can be acute or chronic, and can be worse with standing and sitting, or better with laying down. Of note: in my experience many patients including myself have these symptoms not because of physically herniated disc but rather by the stretching of a nerve in the canal as it exists due to severe musculoskeletal rigidity and abnormal posturing.
Nocturnal Leg Cramps Take Their Toll
Most nights I awake about 2 a.m. writhing in pain, drenched in sweat, and yelling for help. One of my legs is spasming out of control and the muscles feel hard to the touch. I try to move my leg, to forcefully extend it outside of the curled up ball that is now me, but it is too rigid to change position.
Tony, I cant move, I call to my husband, trying to tone down the panic Im feeling. Im paralyzed.
No, youre not, he responds as he sits down beside me on our bed, massages my limbs, and calmly reassures me that my cramping will relax in 10 minutes and we will go to the kitchen to have a snack, just like we always do. Thankfully, he is right.
The first I heard of nocturnal leg cramps was about two years ago when I started experiencing them myself. Gaining in frequency and intensity over time, the cramping has risen to the number 1 spot on my personal list of favorite PD symptoms, dropping incontinence to number 2. Imagine how painful leg cramps are that they beat out incontinence and the inconvenience and embarrassment that accompanies it.
- Narrowing of the arteries that deliver blood to the legs.
- Compression of the nerves in your spine.
- Too little potassium, calcium, and magnesium.
Muscle cramps and dystonia occur when muscles tighten or shorten involuntarily. Parkinsons muscle cramps are generally caused by muscular rigidity and reduced movement rather than by muscles contracting.
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Shakedown: Side Effects Of Levodopa
Hallucinations
Hallucinations and psychosis are a side effect of levodopa. They tend to manifest as disturbances of perception as opposed to sound. According to a report published last year in Psychiatric Times, Management of Psychosis in Parkinson Disease by Dr. Weiss and Sam Adler, MD, After having Parkinsons for many years, benign hallucinations occur in approximately 10% to 20% of nondemented patients with PD who receive dopaminergic treatments.
Christopher Hess, MD, assistant professor of Neurology at the University of Florida Center for Movement Disorders and Neurorestoration, says that after having Parkinsons for many years, some people feel like there is a presence in the house . Or it may be a passage hallucination, which Hess describes as fleeting images in the corner of the eye.
As dependence on levodopa progresses, visual hallucinations in direct vision occur. If the hallucinations are mild, says Dr. Hess, patients can stay on levodopa. But in rare cases, the hallucinatory experiences become increasingly vivid and frightening thats when the symptoms evolve into psychosis. Suspicions of harmful plots, spousal infidelity and financial impropriety are a common cluster of delusions encountered in patients with psychosis. In those cases, more monitoring is required, as well as a change in medication or dosage.
Typically, you need to hospitalize a patient till they are stabilized, Dr. Hess says.
Wearing Off
Involuntary movements
Tips For Dealing With Chronic Pain
Chronic pain is one that last more than 3-6 months , or pain that extends behind the expected period of healing. This blog post explains the different types of pain caused by Parkinsons disease and how to address pain brought on by the disease, by medications, or by comorbid disease. It is always best to treat pain before it becomes chronic.
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Increased Urination Urgency And Frequency
Bladder problems are a common occurrence in people with Parkinsons, occurring in 30-40 percent of people with the disease. The most common urinary symptom is a frequent and urgent need to urinate even when the bladder is empty, as well as trouble delaying urination.
Trouble emptying the bladder is a less common feature of Parkinsons urinary dysfunction. It may be caused by difficulty in relaxing the urethral sphincter muscles that allow the bladder to empty.
Pain Is An Unfortunately Common Problem In Parkinsons Disease
Of course, pain is common in the general population, especially among older people. A recent American study found that pain affected about twice as many people with Parkinsons Disease than those of the same age and gender without PD. About 50% of Parkinsons Disease patients in that study suffered from painful disorders. Men and women seem to be about equally affected. A very well described scenario is the patient who is followed for a painful frozen shoulder for a year or so before a tremor develops leading to a diagnosis of PD. Pain clearly plays a major role in quality of life. Everyone with chronic pain enjoys life less, leading to a vicious cycle in which pain causes depression or isolation which in turn leads to more pain.
Parkinson patients suffer from the same pain problems that other people have, often amplified by the motor dysfunction, but they also have additional pain problems which are unique to PD.
One recent review classified the types of pain Parkinsons Disease patients have into: musculoskeletal, in which the pain results from problems with the muscles , bones or joints dystonic, which is due to abnormal muscle contractions caused by the Parkinsons Disease or the medications used to treat it radicular pain, which is feels like the pain caused by pinched nerves central pain, which is presumed due to abnormalities in the brain, and is a continuously present pain that cannot be explained otherwise and discomfort related to an unpleasant urge to move.
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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.
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When Should I Call The Doctor
You should call your healthcare provider if you experience:
- Frequent or severe muscle twitches that affect your ability to work, sleep or enjoy life.
- Seizures.
- Severe headaches.
A Note from Cleveland Clinic
Everyone has occasional involuntary muscle twitches, or myoclonus. But for some people, muscle spasms become disruptive and even dangerous. Your healthcare provider can determine the cause of myoclonus. Medications can reduce the severity and frequency of myoclonic twitches and jerks.
Last reviewed by a Cleveland Clinic medical professional on 09/28/2020.
References
Stooping Or Hunched Posture
People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.
People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.
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Treatment For Dystonia In Parkinsons Disease
The exact relationship between PD and dystonia remains unknown, which makes treatment challenging. The Parkinsons Foundation recommends tracking when dystonia symptoms occur in relation to taking levodopa, the most commonly prescribed medication for PD. If dystonia occurs when levodopa levels are low, such as upon waking in the morning, then your doctor may recommend adjusting the timing or dosage of your medication.
If occurs even when levodopa has achieved peak levels in your body, then your doctor may recommend injections of botulinum toxin to the affected muscles. Botulinum toxin relaxes muscles and makes it difficult for them to contract, even involuntarily. The injections are repeated every few weeks.
also has shown promise for relieving dystonia in Parkinsons disease . However, sometimes DBS can trigger a dystonia, such as eyelid twitching, so this treatment usually is reserved as a last resort.
As a symptom of Parkinsons disease, dystonia can inhibit you from pursuing physical activities you enjoy. But exercise and physical activity are powerful tools in managing PD. Work with your doctor to find medications that improve dystonia symptoms and keep you as mobile as possible. Staying active can help you maintain a high quality of life when living with PD.
Opening The Medicine Box In The Mind: The Psychology Of Pain
In this 50-minute lecture, Beth Darnall, PhD explains how our experience of pain goes beyond the physical sensation of pain. It has emotional and psychological components that affect our ability to treat pain. She cites research to demonstrate that and shares 13 specific tips to reduce the experience of pain and increase treatment effectiveness. Audience questions follow the lecture.
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Muscle Rigidity: Lead Pipe And Cogwheel Rigidity
Muscle rigidity due to Parkinsonâs disease can be misdiagnosed as arthritis or general tightness from aging. Rigidity can affect your legs, arms, torso, and face. â
What rigidity feels like. Your muscles may feel tight and difficult to move. They may also stiffen involuntarily like a muscle spasm. This stiffness can also cause joint and muscle pain.
Rigidity and everyday life. This type of stiffness can start impacting your normal functions. Simple tasks like cleaning, exercise, and fulfilling hobbies can become difficult because of rigidity. You may also experience:
- Stiffness in your facial muscles that make it difficult to express yourself
- Stiffness while sleeping that make it difficult to get comfortable and sleep well
- Constant tension in your muscles that leads to muscle fatigue and a lack of energy
- Difficulty with certain motor skills, like writing or getting dressed
- Stiffness in your arms that make it harder to maintain balance while walking
Lead pipe rigidity. This type of stiffness is characterized by a feeling of frozen muscles. The muscles feel stuck and unable to move. â
Attempts to move those limbs are met with resistance throughout the motion. They feel stiff and heavy like a âlead pipeâ for sustained periods of time.
Cogwheel rigidity. This type of rigidity is similar to muscle spasms. The limbs experiencing the stiffness can move in small jerking motions, like a ratchet. You may even feel small clicking sensations when moving your arm. â