First Person: Pain in Parkinson’s Disease: Sources, Impacts, and Treatment

In 85% of Parkinson’s patients pain is a major complaint. Some experience pain as an early symptom of Parkinson’s before their disease is even diagnosed. Unfortunately, pain in Parkinson’s disease often remains undiagnosed and untreated. But pain is a troubling symptom of Parkinson’s patients and they need to learn ways to manage it.

As a Parkinson’s patient, I understand that pain goes hand in hand with Parkinson’s in most cases. Even prior to my diagnosis in Sept. 2009, I was experiencing daily pain in my upper back, neck, and shoulders, which is the most common areas of the body where people with Parkinson’s. I also experience an extreme inner restlessness which is like a constant tremor on the inside of my chest area. This type of restlessness is known as akathisia and is believed to be caused by the “gold standard medication” Sinemet prescribed for relief of Parkinson’s symptoms.

Five Categories of Pain Sources in Patients with PD

#1 pain from the muscles or skeleton

# 2 pain from nerves or spinal roots

# 3 pain related to sustained twisting or writhing

# 4 discomfort from akathisia (inner restlessness)

#5 pain caused directly by changes in chemicals in the brain due to Parkinson’s

Causes of Pain in Parkinson’s

Pain in Parkinson’s seem to result from tissue that is injured or has potential to be damaged caused by persistent tremor, muscle rigidity, dystonia, sprains, bruises, bone fractures resulting from a fall, burns and inflammation. Dystonia is easy to be diagnosed when there is visible twisting, cramping, or posturing of a painful body part. Toe and calf cramps are common, which I experience periodically.

Impacts of Pain in Parkinson’s

Chronic pain left undiagnosed and untreated may interfere with day-to-day activities, mood, malnutrition, social withdrawal, depression, anxiety, impaired cognition, and physical and functional decline. Patients who have depression and chronic pain tend to negatively affect the way they perceive their pain.

Assessing and Managing Pain

First, a PD patient must report their pain to their doctor so they can assess pain and make a management plan specifically for you. They will assess your pain through a clinical interview and neurological examination performed in both the un-medicated state and when the Parkinson’s meds are working.

Management Pain Options (pharmacological and non-pharmacological)

Treatment options for pain in PD patients may include medications, physical therapy, massage, nutrition management, exercise (critical), acupuncture/acupressure, psychotherapy (with emphasis on pain management) and stretching.

My current pain management program includes Clonazepam for muscle tension and anxiety, Cymbalta for depression which enhances pain, exercise and stretching to relax muscles and reduce stress, and Trazodone to help me sleep well in order to manage my pain.

The main thing to remember if you have PD and are experiencing pain which interferes with your quality of your life; tell your doctor or neurologist so that a pain management program can be devised specifically for you.

Note: The information provided in this article is for informational purposes only and in no way should substitute for advice and treatment by a qualified doctor.

References:

Publication of Parkinson’s Disease Foundation News Review for winter 2012
Article by Jeffrey Wertheimer, Ph.D.; Understanding Pain in Parkinson ‘s disease

http://www.primehealthchannel.com/akathisia-definition-symptoms-causes-and-treatment.html; primehealthchannel.com

http://parkinsons.about.com/od/treatmentoptions/a/PD_treatments.htm; parkinsons.about.com

Personal experience as a PD patient


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