Monday, September 26, 2022

Parkinson’s Disease Pain Management

Pain In Pd: Assessment And Classification

Using Physical Medicine to Reduce Parkinson’s Disease Pain

In order that novel and optimal pharmacotherapeutic targets may be identified, a deeper understanding of the pain circuitry in PD patients who experience persistent pain is required. Since we know that unique maladaptive changes occur in central modulatory pathways that govern pain and neurodegeneration, identifying pathophysiological hallmarks for persistent pain and Parkinsons disease states, likely highly plastic and stage specific, is crucial.

Pain In Pd: Current Treatment

Pain is a multi-dimensional experience involving sensory discriminative and affective motivational descriptive axes. As such, pain perception is inherently subjective and influenced by multiple factors. While acute pain reflects an adaptive survival mechanism, persistent pain negatively impacts the quality of life of the affected individual and serves limited evolutionarily advantage. Unfortunately a large proportion of people with PD experience persistent pain and 50% of those individuals receive no or inadequate treatment,. Therapeutic strategies that offer an improved analgesic profile remain an unmet clinical need. Clearly multi-disciplinary approaches for pain management that encompass new concepts in pathogenesis and treatment are required,.

Initiation Propagation And Maintenance Of The Pain State

While we do not know the underlying mechanisms that drive PD singular, persistent pain singular, nor persistent pain in PD, bench and bedside research investigative efforts have partially defined some of the factors important in the initiation, propagation and maintenance of each. Continued forward and back translational preclinical and clinical research will provide comprehensive disease pathology insight and guide towards a mechanism based therapeutic approach to facilitate analgesic target identification. Psychophysical testing in humans, with its promise to link animal and clinical pain studies, is essential to fully understand the mechanisms that contribute to the development of persistent pain.

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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 .

Managing Chronic Pain In Parkinsons Disease

Promising New Therapy For Parkinsons Disease  Southwest Florida

Behind every beautiful thing, theres some kind of pain. Bob Dylan

You feel your strength in the experience of pain. Jim Morrison

An Aging Population with Chronic Pain: The definition of chronic pain is pain that continues beyond the expected time of healing. Chronic pain can increase frailty, and its linked to falls, sleep disruption, depression, anxiety, and reduced physical function . Rene Leriche described physical pain as, Physical pain is not a simple affair of an impulse, traveling at a fixed rate along a nerve. It is the resultant of a conflict between a stimulus and the whole individual.

You are not alone living with chronic pain. The number of older adults is quickly growing, and those very old adults with substantial pain and frailty are increasing even faster. Reports in the literature show that ~50% of community-based older adults describe pain daily. Moreover, this population of people does not also have Parkinsons.

Be patient and tough someday this pain will be useful to you. Ovid

Chronic Pain in Parkinsons: You are not alone living with chronic pain in the presence of Parkinsons. In the first medical description of Parkinsons in 1817 , James Parkinson noted that pain was a symptom in the original groups of patients he observed .

Pain is the great teacher of mankind. Beneath its breath souls develop. Marie von Ebner-Eschenbach

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Parkinson’s Pain Can Be Linked To Depression

If exercise and/or adjusting your medications do not help with the pain, ask yourself and your healthcare provider if you might be depressed. Pain in Parkinson’s disease is linked to depression, and treating the depression may help to diminish any persistent pains. Depression affects about 40% of people with Parkinson’s. In some cases, psychotherapy may alleviate pain from Parkinson’s.

If you don’t have depression or if the pains persist after treating your symptoms of depression, then you may want to consider seeing a pain specialist before taking over-the-counter remedies. Pain control specialists have a whole array of pain control treatments and techniques, ranging from special medications to special surgical procedures, that are known to be effective.

How Is Pain Diagnosed Assessed And Treated

Diagnosing and treating pain in people with Parkinsons can be difficult and often, common ways of reducing pain, such taking painkillers or doing regular, gentle exercise may not help.

Usually, your doctor or Parkinsons nurse specialist will be able to help you to manage the more common types of pain, such as shoulder pain and headaches. Certain other types of pain, however, such as pain caused by involuntary movements or burning mouth, may need the help of your Parkinsons specialist.

Completing a Kings Parkinsons Disease Pain Questionnaire and showing it to your heath-care professional will help them to understand the pain you are suffering from1. Completing the 24-hour Hauser2 diary, a home diary designed to assess your motor symptoms, over the same period of time, would further help your doctor or Parkinsons nurse to better understand the pain you are experiencing and to treat it more quickly.

To ensure Parkinsons pain is assessed and diagnosed efficiently, a specific scale has been designed. Kings Parkinsons Pain Scale 1 is a validated scale which covers the common types of Parkinsons related pain. Your Parkinsons specialist might use this scale to help understand the type of Parkinsons pain you have even better and assess what needs to be done to help you further.

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Chronic Pain In Parkinsons Disease

Resting tremor, stiffness, loss of balance, trouble speaking, and eventually, neurocognitive decline are the symptoms commonly associated with Parkinsons disease. Lesser known, but severely contributing to the degrading quality of life in Parkinsons, are the various manifestations of chronic pain that can present . Compared to the general population of similar age, Parkinsons patients have been confirmed to suffer from a significantly higher level and prevalence of pain . It is important to categorize and describe this pain in Parkinsons, as it often persists unrecognized in patients suffering from the disease who otherwise could benefit from tailored treatment . The types of chronic pain understood to be resulting from or exacerbated in the Parkinsons patient are musculoskeletal pain, dystonic pain, nerve pain, primary pain, akathitic pain, and gastrointestinal . An overview of the types of pain and their treatments can be found summarized in table 1.

Table 1. Treatment and Pain Type.

Pain Type

Peripheral and Central Neuropathic Pain

Carbidopa-Levodopa

Rotigotine

How Is Pain Treated In Patients With Parkinson Disease

Mindfulness Monday – Mantra for Pain Relief with Parkinson’s Disease

Pain serves as 1 of the most frequent nonmotor complaints in patients with Parkinson disease , affecting 68% to 95% of patients across all clinical stages. Published in the Journal of Parkinson Disease, researchers highlight that similar to PD, pain is complex and even has different classifications of subtypes within the disease.

While prominent, real-life pain data in PD remains scarce. Researchers sought to provide an overview on pain in PD, including classification, assessment, presentation, and the existing therapy landscape.

As researchers highlighted, todays classifications of pain in PD include musculoskeletal, radicular/neuropathic, dystonia-related, akathic discomfort/pain, and central pain. Notably, the difference in pain directly related to PD and central pain, which is attributed to objective painprocessing and pain-perception disturbance within ascending and descending pathways, was referenced. Most frequently, pain presents as musculoskeletal/nociceptive pain in PD patients, but in nearly half of the PD population, comorbid conditions, such as spine and joint arthrosis, serve as contributors.

When it comes to treating pain in PD, interventions remain a major unmet need as only approximately 50% of those with the disease receive at least some type of pain therapy. In managing pain, researchers recommend that therapy should be optimized to address dopaminergic issues, which has been shown to be effective in 30% of patients with PD.

Reference

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Pain Relievers And Other Options

If you’re in pain, your healthcare provider may suggest you take over-the-counter pain relief medications such as Motrin , Aleve or aspirin. These medications may work to relieve minor aches and pains that you experience from your Parkinson’s disease due to immobility, stiffness, and rigidity.

However, your healthcare provider may want to try some other remedies first. These options include:

  • Adjusting your Parkinson’s medications. Since pain can be caused by the muscle-related symptoms of Parkinson’s disease, it’s possible that it can be managed by adjusting the medications prescribed to manage those symptoms. Your healthcare provider is the best judge of whether this is possible, and how to accomplish it.
  • Exercise. Again, most persistent pains in Parkinson’s are due to the motor problems associated with the condition. An exercise program can help you alleviate those motor problems, which should, in turn, cause the accompanying aches and pains to diminish. Talk to your healthcare provider about starting such an exercise program.

Other options to treat pain in Parkinson’s disease include massage, physical therapy, and stretching.

Managing Pain In Parkinson’s

This article summarizes the incidence, types, and causes of reported pain in Parkinson’s Disease . A table of recommendations on how to involve patients with Parkinson’s in their own pain management is provided, along with approaches to pain assessment. Finally, there is a discussion of pain management principles in PD, including optimization of dopaminergic medications, use of analgesics, and innovative treatments for pain management .

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Search Strategy And Literature Sources

We reviewed both pharmacological and non-pharmacological treatments for pain in patients with PD. We searched for studies cataloged in PubMed and the Cochrane library, to October 31, 2019. An initial search was conducted between February and June 2018. An updated search was performed in November 2019 to look for new publications. The keywords Parkinson, pain, and treatment OR management were combined with and to search within the title and abstract fields for each database. We also included relevant keyword derivatives, such as Parkinsons Disease, Parkinsons, and PD. In addition to the title and abstract fields, we searched reference sections for all included articles.

What Can I Do On A Regular Basis To Manage My Pain

Parkinson

Remember, youre your best advocate as you understands how your pain feels. Understanding and communicating the kind of pain youre experiencing can greatly inform your treatment plan and will allow your doctors to address the type and severity of your specific pain. Keep your care team informed about activities that cause pain or the times of day your pain is worst so they can help fine-tune your care plan. Do you notice the pain starting to creep in at a certain point after you take your medication? Do you feel fine when you bike but experience pain when you jog? Did you start experiencing this pain before or after your Parkinsons diagnosis? Taking stock of these sorts of questions can be helpful as you work with your care team to effectively treat your pain.

Incorporating approved medications and following the pain ladder can also help you find the right pain management solution, as can taking steps in your everyday life to be an active participant in your own pain management. Regular stretching, heat and cold treatments, exercise, yoga, and dance can all help reduce your pain, and they are all steps that you can take on your own. Making adjustments to your home and workspace, such as minimizing places where fall risks are likely, using an ergonomically designed desk, sleeping in a comfortable bed, and wearing clothes and shoes that dont exacerbate pain, can help you establish a more pain-free daily routine.

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Painful Symptoms Of Parkinsons Disease

Pain can sometimes be an early symptom of PD. For example, a person may complain of a painful shoulder and be diagnosed with an orthopedic condition such as a frozen shoulder, only to develop a rest tremor on that side at a later point. The painful shoulder was in fact not a frozen shoulder after all, but rather pain due to the rigidity of PD. Now of course, sometimes a frozen shoulder is really just a frozen shoulder, so theres no need to jump to conclusions when you are experiencing pain. Not every ache and pain is a sign of PD, but it is important for you to educate yourself, be aware of the possible connections, and be proactive about seeking medical attention for any notable pain you are experiencing.

If you have PD and develop pain, it is important to first bring this to the attention of your doctor. The pain may be related to your PD, or the pain may be due to a common problem such as arthritis which is exacerbated by your PD. However, in some cases, it may be a symptom of a more serious medical problem. So do not assume that the pain is related to your PD before getting an appropriate medical workup.

Treatment Of Chronic Pain In Parkinsons Disease

Effective management of chronic pain conditions is a difficult task, with up to two thirds of patients reporting dissatisfaction with their treatment results. Unfortunately, PD is not exempt from this reality and achieving satisfactory outcomes when managing chronic pain in PD patients is exceptionally challenging. The extensive heterogeneity of pain that is experienced in PD patients presents obstacles in identifying targets for treatment. Furthermore, a lack of controlled studies has left a dearth of evidenced based treatment recommendations, and current regimens are largely based on case reports and empirical evidence . Nevertheless, an array of pharmacological and nonpharmacological treatment options is available to attempt to relieve the chronic pain symptoms of PD patients. The treatment options are summarized in table 2.

Table 2. Treatment Options.

Anti-depressants

Anti-convulsant

Cannabis

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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.

Mechanisms That Contribute To Persistent Pain In Pd

Pain and Parkinson’s

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 To Deal With The 6 Common Causes Of Leg Pain In Pd

Severe leg pain is a common complaint from people with PD. Lately, it is understood that central pain is common to Parkinsons disease, and can even be the first sign of PD, usually bilaterally. This blog post lists six causes of lower limb pain, and the importance of treating it. Treatments depend on properly identifying the source of pain. Some treatment suggestions are included.

Implications For Clinical Practice And Research

Our findings show that safinamide is an important adjunct to the standard parkinsonian medications for alleviating pain in PD. Analgesics in the form of opioids and cannabinoids were shown to be effective but not nearly to the same extent. Thus, they are an important consideration if a patient responds poorly to safinamide. Although analgesic therapy is effective, only one-half of PD patients with pain report having used them . Nègre-Pagès et al. found that analgesic use was lower for patients with PD pain as opposed to non-PD pain despite greater indices of pain severity and impairment of health-related quality of life. This may have arisen from the fact that PD pain was reported less frequently and/or because dopaminergic drug adjustment may have been preferred for PD pain treatment instead of analgesics. In light of our findings, it appears that dopaminergic drug adjustment yields little benefit, whereas adjusting levels of levodopa via entacapone may be a more favorable strategy. A multidisciplinary team approach is also recommended however, additional studies with different team compositions need to be conducted to determine which teams work best. Furthermore, more trials of high methodological quality focusing on different aspects of pain as well as the pathophysiological mechanisms of pain in PD are needed to form a consensus on the effectiveness of these therapies on patient-important outcomes related to pain.

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Pain Is A Common But Overlooked Problem In Parkinsons Disease

Pain is an often overlooked non-motor symptom of Parkinsons disease . Studies show that between 40-80% of people with PD report pain, which is likely why it is often suggested as a topic for this blog.

One of the reasons why the topic of pain and PD is difficult to address is that it is sometimes tough to discern whether a particular pain is due to PD or not. Chronic pain is such a common symptom among the general population, and people with PD are not immune to common problems as well. However, there are aspects of PD that may exacerbate the pain experienced from a common problem. In addition, there are particular types of pain that may be unique to people with PD.

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