Monday, July 25, 2022

Shoulder Pain And Parkinson’s Disease

Can Parkinsons Disease Be Prevented

Chiropractic Care for Parkinson’s Disease, Shoulder Pain, Back Pain, and More

Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.

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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.

What Are The Different Stages Of Parkinsons Disease

Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

Early stage

Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

Mid stage

Mid-late stage

Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

Advanced stage

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Complementary And Alternative Medicine

In addition to pharmacologic and interventional treatments, several complementary and alternative therapies have also been investigated for alleviating PD pain. The designation of alternative medicine is a bit of a misnomer as these treatments are typically used alongside traditional pharmacologic and surgical interventions. A number of studies have examined the benefits of complementary therapies, but there is a lack of large-scale, high-level research and results are mixed regarding their effectiveness. Fortunately, most complementary therapies are safe and well-tolerated, and current literature, though limited, does suggest a role for including these therapies as a component of a multimodal approach to pain treatment.

Finally, there has been some research into the use of cannabis for pain treatment in the setting of PD. In two small, open-label, observational trials in PD patients, cannabis was found to improve pain scores as well as significantly decrease heat and cold pain tolerance . The authors postulated that cannabis acts on PD pain via modulation of the peripheral and central pathways . While no adverse effects were found in these trials, unlike with other complimentary therapies, cannabis use carries the risk of unpleasant side effects. Patients must be aware of the potential for paranoia, delusions, breathing problems, increased heart rate, and nausea. These side effects are typically dose related with incidence increasing with higher doses.

How To Exercise With Parkinsons

Sore shoulders

Whether you’re a first-time exerciser or a lifelong athlete, the key to working out with Parkinsons is to safely and regularly move your body in a variety of ways. Your fitness regimen should include these four main categories of exercise:

  • Aerobic activity
  • Balance, agility, and multi-task exercises
  • Stretching

People with Parkinsons should strive to perform aerobic activity at least three times weekly and to complete exercises from the other categories two to three times each week.

In total, the Parkinsons Foundation suggests performing 150 minutes of moderate tovigorous exercise weekly.

To help you achieve this goal, try these helpful tips:

  • Invest in a treadmill, elliptical, or exercise bike. This will make it convenient to perform aerobic exercise from your home, regardless of the weather.
  • Obtain a set of light hand weights from a local exercise shop or thrift store. These can be used for a wide variety of strength training exercises.
  • Follow along with one of the many online exercise classes on YouTube that are tailored to people with Parkinsons disease. The Parkinsons Foundation and the Davis Phinney Foundation offer many great online exercise videos.
  • Connect with a workout buddy by finding a local Parkinsons support group associated with the American Parkinson Disease Association

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Q Are There Any Alternative Therapies That Are Effective For Pain In Pd

Dr. Fleisher: Although alternative therapies may be helpful, there is little evidence-based research to support their use. Certainly massage therapy, anecdotally, seems to be helpful for managing pain. Small studies suggest that acupuncture might improve sleep in patients with PD, but data on the effects on pain in PD is lacking. Larger, more well-controlled and reproducible studies of these therapies are needed.

Patients frequently ask about the effects of medical marijuana in managing PD, including pain symptoms. Several studies have looked at efficacy of marijuana in PD and have found that it probably is ineffective for most PD symptoms.11 However, we just dont have enough evidence to know for sure. The most rigorous study of medical marijuana in PD showed a trend toward worsening tremor.11,12

For most people, stress and anxiety worsen tremor, and anything that relieves anxiety will improve tremor. Thus, modalities such as yoga, meditation, and mindfulness training will improve tremor. Similarly, medical marijuana may improve tremor in certain people by temporarily reducing anxiety and stress, but the evidence has not borne this out yet.

If You Experience Stiffness In Your Shoulder It May Be Due To Parkinson’s

While those with Parkinson’s may experience stiffness in several body parts, experts say that having “frozen shoulder,” also known as adhesive capsulitis or periarthritis, is particularly linked with PD. “Shoulder stiffness is, in fact, one of the conditions associated with Parkinson’s disease, a neurodegenerative disorder caused by a lack of dopamine in the brain,” explains Very Well Health.

When a patient develops frozen shoulder, the connective tissues that encase the bones, ligaments, and tendons in that area thicken and tighten around the shoulder joint. When this happens, movement becomes restricted, causing pain and stiffness.

According to the Mayo Clinic, symptoms of frozen shoulder “typically begin gradually, worsen over time and then resolve, usually within one to three years.” The health authority says this often occurs in three distinct stages: the freezing stage, the frozen stage, and the thawing stage. In the freezing stage, the patient typically experiences reduced range of motion along with joint pain in one shoulder. The frozen stage is typically less painful, but as the shoulder becomes stiffer, many people lose most or all function in the affected shoulder. In the thawing stage, the patient begins to regain range of motion.

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How Is It Categorized

Doctors categorize pain as nociceptive, which refers to pain from tissue damage, or as neuropathic, which refers to pain that arises from the nerves. Some pain is both nociceptive and neuropathic. Most people with PD experience nociceptive pain.

This type of pain is generally localized to a specific area of the body. The most common areas for people with PD to experience pain are the neck, upper back, and the extremities . Neuropathic pain is less common in PD, although it may be caused by akathisia, an extreme restlessness.1

The pain caused by PD can generally be classified by one of five causes:

  • Musculoskeletal pain related to poor posture
  • Nerve or root pain, which is commonly related to arthritis in the neck or back
  • Pain due to dystonia, the prolonged twisting or contraction of a muscle group
  • Discomfort due to extreme restlessness
  • A pain syndrome known as “primary” or “central” pain that arises from the brain1
  • It Can Sometimes Be The First Symptom Of Pd

    My Parkinsons Story: Pain

    According to a 1989 study published in the Journal of Neurology, Neurosurgery, and Psychiatry , roughly 43 percent of Parkinson’s patients reported having shoulder complaints. A second study from 2015 published similar findings: 46 percent of their subjects with PD specifically experienced frozen shoulder.

    Notably, the JNNP study also found that frozen shoulder was the first symptom of disease in 8 percent of their PD subjects, appearing up to two years before more traditional symptoms. “Although it seems intuitive that immobilized patients in the later stages of their illness might have a high incidence of shoulder disturbances, we have been impressed that a number of our patients have experienced difficulties before other features of Parkinson’s disease were recognized,” the team wrote.

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    What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

    Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

    Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

    Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

    My Parkinsons 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 Parkinsons disease. The doctors explain that pain is common in Parkinsons disease, often due to rigidity or dystonia, which can be exacerbated by off periods. Pain caused by Parkinsons symptoms can be relieved by Parkinsons medications, exercise, DBS and botox injections. Pain is an invisible symptom that should be mentioned to your neurologist.

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    Improve Your General Fitness

    Increasing your level of fitness will help you manage your weight and ensure your joints arent under any added pressure. You could try walking, swimming, dancing, cycling or aerobics its up to you.

    Many of Parkinsons UKs local groups have physiotherapist-led exercise classes you can join. Visit our Local Support page or call our helpline on 0808 800 0303 to find one near you.

    Im In Pain But I Dont Want To Take Carbidopa/levodopa Yet Because My Doctor Says It Will Only Work For Five Years Any Advice

    A4 Exercise Chart: Parkinson

    It is true that as time passes and your disease progresses, you will have to take higher doses to replace the dopamine your body can no longer produce. However, the rate of dopamine loss is different for everyone. What your doctor may be telling you is that after taking carbidopa/levodopa for some time, you may begin to experience side effects like dyskinesia. It is important to understand that while you may experience this unwanted side effect, for example, you still benefit from the carbidopa/levodopa. If you believe your pain is Parkinsons-related, and you have already tried other medications and complementary therapies without relief, it is probably time to try carbidopa/levodopa.

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    Shooting Pain And Paraesthesia

    Radicular pain is a sharp pain that shoots down a limb and often affects fingers or toes. Paraesthesia is sometimes described as a feeling of pins and needles or perhaps numbness in a limb which has fallen asleep. Such pain is usually related to trapped nerves in the spinal cord and can feel similar to an electric shock, a tingling or a burning sensation.

    Treatment: Painkillers and exercise will generally settle the pain. If not your specialist may refer you for tests such as an MRI scan to check for a trapped nerve in the spinal cord.

    Parkinsons Home Exercise Program

    You dont need to join a gym or purchase expensive fitness equipment to stay active with Parkinsons disease. On the contrary, there are many great exercises that you can do from the comfort of your home, regardless of which stage of the disease you are in. Take a look at some great examples in the sections below.

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    What Causes Parkinsons Disease

    Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

    People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

    Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

    Is Accurately Targeted Treatment Possible

    PDontheMove – My experience of shoulder surgery for Parkinson’s

    Single targeted surgery enables Parkinsons Syndrome Sufferers to be precisely treated with the minimum of damage to tissues, reduced patient risk and enhanced long-term outcome and more essentially without the use of General Anaesthesia. This treatment, which is called Foraminoplasty because it is carried out in the gaps or Foramen between the vertebrae, allows the nerve to thoroughly liberated and the overriding joints or pointed fracture margins to be removed. This is only possible by the use of Endoscopic Minimally Invasive Spine Surgery where the full length of the exiting nerve can be explored and the points of irritation clearly demonstrated. In the breadth of presentations arising from Degenerative Disc Disease and Failed Back Surgery or Failed Chronic Pain management, Endoscopic Lumbar Decompression & Foraminoplasty achieved a successful enduring positive outcome in 80% of cases.

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    Q What Role Does Exercise Play In Pain Management In Pd

    Dr. Fleisher: Exercise and physical therapy can be tremendously helpful in managing pain in PD, in addition to being important for overall disease management.4,8 Evidence suggests that exercise is the best option we have to alter the course of PD, and it has been shown to promote neuroplasticity and neurorestoration in PD.9,10 In addition, research suggests that exercise can activate both dopaminergic and non-dopaminergic inhibitory pain pathways, which may help to modulate the experience of pain in PD.10

    Good exercise options include walking, swimming, dancing, and using a recumbent bike. In particular, forms of dance with smooth movements and those that encourage bigger steps appear to be especially beneficial in helping retrain the brain that the shuffling gait of PD is not the norm. Incredible work has come out of the Mark Morris Dance Company, in New York City, which has started a Dance for PD class that has spread throughout the country. In addition, yoga and tai chi can help with balance and core strength, which are critical for people with PD.

    Importantly, there doesnt appear to be an upper limit for the benefits of exercise on the disease. I encourage patients to aim for at least 30 to 45 minutes a day at least 3 to 4 days a week. Patients who are sedentary should start with 5 minutes per day for a week, and then increase the duration each week.

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    Parkinson’s Causes Five Types Of Pain In The Body And It Works

    For more information:

    The onset of Parkinson’s disease is slow, and the first symptoms often go unnoticed. However, when the following symptoms appear, the clinical diagnosis of Parkinson’s disease can be basically made. The disease is mainly due to the decrease in the synthesis of dopamine and the decrease in the function of inhibiting acetylcholine after the pathological changes of the cells located in the substantia nigra of the midbrain, and the excitatory effect of acetylcholine is relatively enhanced. The result of the imbalance between the two is tremor paralysis.

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