Parkinson’s Neck Pain Treatment

Dystonia Pain And Parkinsons

What it feels like:

This is pain due a Parkinsons symptom called “dysonia which are muscle contractions that can cause twisting or abnormal postures. Dystonias can be focal, meaning they impact one area of the body. Examples include writer’s cramp, neck pulling , cramping of your vocal cords, or strong foot cramps.

Sometimes they can be be more extensive involving entire limbs or even be generalized throughout our body.

Treatment modalities to consider:

• A good place to start is assess if adjustments need to be made to the Parkinsons medication dosing you are already on.

• Techniques that can elicit the relaxation-response

• Botox injections in the affected muscles

• Anti-cholinergic or muscle relaxants

Sciatica & Back Pain Relief

According to the American Physical Therapy Association, back pain is the most commonly reported pain across the nation, and one out of every four Americans has experienced back pain in the past three months. Back pain usually results from an injury or strain.

Sciatica, a specific type of back pain involving nerves that span into the legs, is also very common.Whether you are suffering from general back pain or sciatica, working with our physical therapists can help relieve the discomfort in your back and restore your health. Physical therapy may even eliminate your need for harmful painkilling drugs, such as opioids, or an invasive surgical procedure. If you are experiencing back pain, contact our office today. Our skilled physical therapists will create an individualized treatment regimen for you, focusing around your recovery.

Treating Dystonia With Botox

Listen to Dr. Diaz on The Think Neuro Podcast mini talk about how botox can ease can help ease the symptoms.

Cervical dystonia refers to the abnormal posture of the muscles of the neck, resulting in a twisted, turned, flexed or extended neck position. This strained positioning is brought on by abnormal signals coming from the deep parts of the brain. Because it is of neurological origin, from brain signals, its not the same as having a crick in ones neck and wont resolve with muscle massage or stretching. The word cervical in the term cervical dystonia should not be confused with the female reproductive organ, known as the cervix. The word cervical comes from the word cervix, which literally means neck. The female cervix refers to the neck of the uterus if you imagine the uterus to be the head, the cervix is its neck. Cervical dystonia, then, is the medical term for neck dystonia. Both men and women can be affected.

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Who Does It Affect

The risk of developing Parkinsons disease naturally increases with age, and the average age at which it starts is 60 years old. Its slightly more common in men or people designated male at birth than in women or people designated female at birth .

While Parkinsons disease is usually age-related, it can happen in adults as young as 20 .

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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How Do I Take Care Of Myself

If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.

• Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinson’s disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
• See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
• Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.

What Medications And Treatments Are Used

Medication treatments for Parkinsons disease fall into two categories: Direct treatments and symptom treatments. Direct treatments target Parkinsons itself. Symptom treatments only treat certain effects of the disease.

Medications

Medications that treat Parkinsons disease do so in multiple ways. Because of that, drugs that do one or more of the following are most likely:

Several medications treat specific symptoms of Parkinson’s disease. Symptoms treated often include the following:

• Erectile and sexual dysfunction.
• Hallucinations and other psychosis symptoms.

Deep brain stimulation

In years past, surgery was an option to intentionally damage and scar a part of your brain that was malfunctioning because of Parkinsons disease. Today, that same effect is possible using deep-brain stimulation, which uses an implanted device to deliver a mild electrical current to those same areas.

The major advantage is that deep-brain stimulation is reversible, while intentional scarring damage is not. This treatment approach is almost always an option in later stages of Parkinson’s disease when levodopa therapy becomes less effective, and in people who have tremor that doesnt seem to respond to the usual medications.

Experimental treatments

Researchers are exploring other possible treatments that could help with Parkinsons disease. While these arent widely available, they do offer hope to people with this condition. Some of the experimental treatment approaches include:

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Can Parkinsons Affect Your Bowels

If you have Parkinsons, you may be more likely to have problems with your bladder or bowels than people of a similar age without the condition. Some of these problems are common in men and women of all ages, whether they have Parkinsons or not. Bowel problems are very common in the general public.

Neck Pain Caused By Dyskinesia

About 6 months ago, my dyskinesia started getting worse, and I noticed I was starting to get a lot of neck pain.

I went to a neuro PT who said she thought my neck pain and stiffness were being driven by my dyskinesia and that I needed to reduce the dyskinesia before we could improve my neck. So I tried amantadine but because of its side effects I can only take 1 per day. And it doesnt seem to help at any rate. So then I experimented with dosing of CL – minimize usage. But havent been able to find a balance that works. Now Im experimenting with Rytary. No luck yet.

If I cant eliminate dyskinesia, is there any kind of PT that can at least help reduce neck pain?

This is a major problem for me because beyond the pain, I was reliant on running and exercise as therapy. But with the neck pain, Im lucky to be able to fast walk for 20 , max 30 minutes!

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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 .

What Does Parkinsons Rigidity Feel Like

Rigidity, while seldom the main symptom early in Parkinsons, is experienced as a stiffness of the arms or legs beyond what would result from normal aging or arthritis. Some people call it tightness in their limbs. Stiffness can occur on one or both sides of the body and contribute to a decreased range of motion.

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Experiencing Pain Or Symptoms That Concern You

Call: 310-582-7433

While it is relatively uncommon, cervical dystonia is by no means rare. Exact prevalence rates are not available, but an estimated 60,000 160,000 Americans are living with cervical dystonia. In one study, only half of these patients reported being treated for their condition. Cervical dystonia often comes on in mid-life but can begin at any age, and typically affects women twice as frequently as men.

In addition to neck pain, many patients may manifest with a head tremor. Often patients assume that tremor is due to more common causes, such as Parkinsons disease and essential tremor. However, isolated head tremor should be considered undiagnosed cervical dystonia until proven otherwise.

A tremor in cervical dystonia tends to be jerky and irregular and often is worse in the direction of the head away from the abnormal positioning. So, if cervical dystonia is causing a head turn to the right, tremor may be worst when the patient attempts to turn their head to the left.

Cervical dystonia is known by many names, and the terminology can get confusing at times. The most common alternate name is spasmodic torticollis, but torticollis may also refer to the specific position of head turning to left or right, whereas head tilt is known as laterocollis. When the neck is extended it is known as retrocollis, whereas neck flexion is known as anterocollis.

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What Tests Will Be Done To Diagnose This Condition

When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:

• Positron emission tomography scan.

New lab tests are possible

Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.

The two tests use the following methods.

• Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
• Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.

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What Is Wrong With Conventional Surgery

The use of multi-level open surgery in Parkinsons Syndrome Sufferers including microdiscectomy, decompression, solid or flexible fusion and is an overkill with negative side-effects including blood loss, potential nerve and tissue damage, extended post-operative care and unnecessarily operating on pain-free levels is fraught with aggravation of the current symptom status. It is not as effective as Foraminoplasty in addressing and ameliorating the effects of Parkinsons Syndrome Sufferers, rather it runs the risk of increased neurological complications as well as causing the complications of recurrent disc bulging, infection, nerve damage and scarring round the nerve, implant failure, major vessel damage or sexual dysfunction.

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.

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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.

Other Symptoms: Aging Or Pd

Because the biggest risk factor for developing PD is age , skeletal problems associated with aging are often experienced by people with PD. While it is not clear that PD increases the risk or even the severity of these other skeletal conditions, the problems of PD can make the symptoms of these conditions more prominent.

• Osteoarthritis, the joint damage associated with general wear and tear on the joints, is nearly universal in aging. Osteoarthritis tends to affect larger joints such as the hip and knee.
• Arthritis of the spine is also very common. This may contribute to the development of spinal stenosis, narrowing of the canal in the spine that houses the spinal cord. In severe cases, spinal stenosis causes damage to the nerves as they exit the spine or even to the spinal cord itself.
• Disorders of the fibrous discs between the bones of the spine can also cause pain, or limb numbness or weakness.

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Parkinsons Disease Risk Factors

• Age: In most cases, people do not develop noticeable signs of Parkinsons disease until they are 60 or older. Only in about 10 percent of cases or less do people develop early onset Parkinsons disease .
• Gender: Men are twice as likely to develop Parkinsons than women. In addition, women tend to be on average two years older than men they develop PD.
• Family history: Around 15 percent of people with Parkinsons have a family member with this condition.
• Ethnicity: Hispanics and Caucasions have the highest incidence of Parkinsons disease while African Americans and Asians have the lowest incidence.