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.
How Does This Condition Affect My Body
Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.
Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.
When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.
As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.
What Is Deep Brain Stimulation Surgery
Today, the most common approach to treating essential tremor when medications no longer help is deep brain stimulation . This form of treatment consists of two staged surgeries to implant an electrode deep into the brain, tunnel the wires under the skin down the neck and implant a pulse generator below the skin near the collar bone. This treatment targets the same location as the Neuravive focused ultrasound treatment. DBS requires follow up throughout the patients life for adjustment of stimulation and eventual replacement of generator to replace batteries. As an invasive surgery to access the brain, DBS poses risks typically associated with surgery, such as infection and bleeding in the brain, and with implantation of chronic hardware in the body, such as infection and potential equipment malfunction.
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Strengthening Exercises Or Stretching May Be Helpful
Imagine that the spine is like a telephone pole or the mast of a sailboat. If the pole is not exactly upright, even a slight tilt requires a great force to keep it from tilting further and falling. In the human body, this means that the lower back muscles are under great stress. It also means that the tension on the back bones is much increased as well. This worsens whatever problems, like arthritis, that are already present. The same process applies to the neck, although the forces are less great. Strengthening exercises or stretching may be helpful. Almost everyone over the age of 60 has arthritis in their spine. Luckily most dont have pain from it, but those who do will have it worsened by the spine curvature caused by the PD.
PD patients also frequently have an aching discomfort in their muscles, particularly in the thighs and shoulders. I think this is due to the rigidity, or stiffness, that is part of the Parkinsons Disease syndrome, but Ive seen many patients with this pain and no apparent stiffness on examination, hence not explained. It is common and it often, but not always, responds to alterations of the usual Parkinsons Disease medications for movement. Exercise and stretching may be helpful as well and should always be tried first before increasing medications.
Pain is a challenge in PD. We cant measure it and often cannot find its cause. It is, however, often treatable, and reducing pain improves quality of life.
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.
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/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.
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Billy Connolly Discusses Parkinsons And Cancer Diagnoses
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Parkinsons disease symptoms mainly relate to movement because the condition results in a loss of nerve cells in the part of the brain responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and coordinate body movements. One area of the body that can be affected is the feet. If stiffness in the feet occurs often, it could be a sign of something more serious.
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/4what Are The Risk Factors Of Parkinsons Disease
The various risk factors associated with Parkinson’s disease are age, genetics, gender, and heredity.
Parkinson’s disease is usually seen in people in the middle or late age. Usually people develop this condition after the age of 60 years. As per health experts, men are more likely to develop Parkinson’s disease than women. Heredity also plays an important factor in increasing the risk of developing this condition.
Another major risk factor which researchers have pointed out is the exposure to toxins. Exposure to pesticides and herbicides, which are commonly used these days, can make you more prone towards the disease.
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.
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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
WHICH PROFESSIONALS CAN HELP?
WHAT CAN I DO TO HELP MYSELF?
TOE SPLINTS
GENERAL FOOT CARE TIPS
What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
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My Parkinson’s Story: Pain
This 10-minute video alternates between an interview with a man and and doctors. The man shares his experience with pain as a symptom of Parkinson’s disease. The doctors explain that pain is common in Parkinson’s disease, often due to rigidity or dystonia, which can be exacerbated by “off” periods. Pain caused by Parkinson’s symptoms can be relieved by Parkinson’s medications, exercise, DBS and botox injections. Pain is an invisible symptom that should be mentioned to your neurologist.
What Is Swelling And What Can People With Parkinsons Do About It
Swelling is a common problem for people with Parkinsons, particularly for those who have movement difficulties. If you’re not very active, fluid can build up in your feet, ankles and lower legs. This is known as oedema. Ankle swelling is also a side effect of some Parkinsons medication.
Swelling can get worse during the day and go down overnight. Sometimes this is called postural oedema because gravity causes the build-up of fluid around the ankles when you stand up.
While the swelling is usually mild, some people describe their legs as feeling heavy. They may also have difficulty putting on shoes because they feel tighter than usual.
Wearing footwear that can be loosened during the course of the day may help, but it is important to make sure your shoes still hold firmly on to your feet to avoid the risk of falling.
Being active can help reduce swelling. Try the following:
- When sitting, have your legs raised on a footstool and exercise your ankles regularly .
- Lie flat with your legs slightly raised on a pillow three to four times a day to help reduce excess fluid.
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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.
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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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What Is Your Advice On Footwear For People With Parkinsons
Make sure your shoes fit well, as shoes that dont fit correctly can damage your feet and increase the risk of tripping or falling.
Try to choose shoes that have a low, broad heel, and that fasten over the top of the foot close to the ankle. Shoes with laces, Velcro or a strap and buckle have a better hold on the foot.
Leather-soled shoes should be avoided as they can increase the risk of trips and falls.
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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Foot Myofascial Release Technique
- Get a tennis ball, softball, or racquetball .
- First be seated or standing holding onto a solid object for balance.
- Place the ball under one foot and start rolling the arch. Dont be afraid to PUSH HARD as you roll.
- Roll along the sides and center, from the toes to the heel, you will feel sore spots. Spend a little more time on these areas.
- You can see Gary can only reach the top of the tongue of his shoe
- We quickly rolled out his feet and voilà ! He could almost touch the ground. That is a 3-inch difference. He was amazed.
- Spend 2 minutes or more on each foot. Dont attempt to touch your toes if you have balance issues, low blood pressure, or in a wheelchair. Just know your hamstrings are a little looser and your feet will still feel amazing.
Its very important to do this daily before your exercises. It will get you ready for action and help prevent injuries. Do it again at night to massage out the abuse your feet take all day. It can address the cramping and curling toe symptoms too.
Photo credit: Morgan
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How Is It Diagnosed
Diagnosing Parkinson’s disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests aren’t necessary unless you don’t respond to treatment for Parkinson’s disease, which can indicate you have another condition.
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Q What Is The Outlook For People With Parkinsons Disease
A. Most people can continue to work full time and lead relatively normal lives for many years after being diagnosed. The disease does not affect your life expectancy, and your age at diagnosis does not seem to have any effect on your long-term outlook. However, due to the progressive nature of the disease, many people do eventually become disabled.