Pain in Parkinson’s: How can it be treated?

Having an understanding of how pain works and how having Parkinson’s disease (PD) can exacerbate pain can be helpful in better understanding ourselves and the symptoms we experience. However, the more important question is — how can I reduce or improve my pain?

Pain can affect up to 85% of patients with PD. Despite how common pain can be in PD, it is a symptom that is largely under treated.

Decreased dopamine in the brain that occurs with PD causes changes in sensory perception and can decrease pain threshold. Research studying the treatment of pain in people with PD finds evidence that decreased dopamine could lead to increased pain sensitivity. Treatment with dopaminergic medications influences not only sensory perception, but also other motor symptoms patients experience that can result in increased pain. Therefore, it is important to optimize dopaminergic treatment for more effective treatment of pain in PD.

Once dopaminergic treatment is optimized, determining the type of pain someone is experiencing plays a large role in determining which type of treatment could be effective for someone. Someone with Parkinson’s Disease may be experiencing musculoskeletal pain, dystonic (changes in tone in muscles) pain, neuropathic pain, or central pain.

Types of pain

• Musculoskeletal pain

  • Result of rigidity, limits in range of motion, arthritic changes, changes in how someone walks, or muscle tenderness.

• Dystonic pain

  • Can change based on medicine dosing causing abnormal movements in muscles causing painful muscle contractions.

• Neuropathic pain

  • Resulting from nerve compression likely due to changes in range of motion causing radiating pain in extremities.

• Central pain

  • Change in how pain is perceived causing burning, tingling, aching, or perceiving pain internally.

Several different forms of treatment have been investigated including medications and treatment without medications. In addition to carbidopa/Levodopa, norepinephrine and serotonin have been used to decrease central pain. Use of deep brain stimulation has also been shown to decrease pain in PD.

Studies have been strongly focused on investigating use of medications for pain relief. Unfortunately, evidence for treatments such as exercise, cognitive behavioral therapy, physical therapy, and massage therapy is quite thin comparatively. Exercise been shown to promote increased connections within the brain to improve pain signals causing an increased pain threshold. Physical therapy can have a strong impact on musculoskeletal pain and neuropathic pain by improving range of motion, decreasing rigidity and promoting more balanced movement patterns when walking. Occupational therapy can also support pain self-management by teaching breathing and relaxation techniques and suggesting activity modifications and equipment to make it easier to do everyday tasks.

If you are experiencing pain, having a conversation with your physician can be an important step in decreasing pain through adjusting medications or with a prescription to physical therapy. You can also call Engage at 315-810-2423 to see how PT and OT can help you live your best life without pain!

References

1. Rukavina K, Leta V, Sportelli C, et al. Pain in Parkinson's disease: new concepts in pathogenesis and treatment. Curr Opin Neurol. 2019;32(4):579-588. doi:10.1097/WCO.0000000000000711

2. Karnik V, Farcy N, Zamorano C, Bruno V. Current Status of Pain Management in Parkinson's Disease. Can J Neurol Sci. 2020;47(3):336-343. doi:10.1017/cjn.2020.13