If you have pain, you're not alone: Surveys of people with Parkinson’s disease (PD) have shown that as many as half of all PD patients experience severe and chronic (greater than 6 months) pain. People with PD, however, don’t usually tell their doctors about this pain, so all too often it goes untreated.
Two Main Types of Pain in Parkinson’s Disease
If you have PD you may experience physical pain from two major sources:
- Rigidity
Muscle stiffness and rigidity due to the disorder - Central Pain
Pain due to central nervous system (CNS) changes.
-
These CNS changes involve that molecule we all love to hate: dopamine.
The pains associated with muscle soreness can usually be treated effectively by adjusting the dopaminergic (e.g. levodopa) dosage levels. Pain associated with CNS changes will usually respond to other medications designed to tamp down pain levels.
Common Pain Complaints Among People with PD
Surveys have shown that at least 74% of PD patients report muscle cramps or tightness, typically in the neck, spinal or calf muscles; 28% reported painful muscle contractions; 14% nerve pain; 14% joint pain, and 2% report diffuse central or generalized pain.
Persistent Neck Pain in Women
Interestingly, women with PD tend to report neck pain as the third most common symptom at onset of disease. This is a potentially important fact that as far as I can tell has not been adequately pursued by researchers. If we can identify early signs of PD we can begin treatment at an early stage and thus slow down progression of the disease. Persistent neck pain in females may be an early sign of PD in females, assuming of course all other reasons for the persistent pain have been ruled out.
Depression and Pain
Depression tends to increase pain severity in persons who have pain. Depression, however, very likely does not cause pain. You can have pain and no depression. Likewise you can be depressed and have no pain syndromes. When depression and pain co-exist, treating the depression will usually help with the pain syndrome as well. Often the pain will diminish dramatically or fewer pain medications will be required. The whole relationship between pain and depression is not yet adequately explored or understood, but it's important to talk to your doctor about both.
Central Pain in Parkinson’s Disease
Central pain is defined as pain produced by abnormal functioning in the central nervous system. Central pain is described as stabbing, burning, shooting or searing. These unusual pains can involve the face, head, stomach, pelvis and genitalia. Sometimes "burning mouth syndrome" can make it feel as if the gums, teeth, jaw and tongue are pulsating and burning.
There IS Help for Your Pain
As mentioned above, most pain is because of the motor problems associated with the disorder. If you alleviate those motor problems (and you can) the troubling aches and pains should diminish.
Also, if you are having feelings of depression, treating the depression aggressively with anti-depressants should also help to lower persistent pains.
See A Pain Specialist
If pain of central origin is present you should arrange to see a pain specialist. Pain control specialists have a whole armamentarium of pain control treatments and techniques from special medications to special surgical procedures, that are known to be effective.
The Bottom Line
Don't try to live with pain. Yes, we can all tolerate some degree of pain, even for long periods of time, but when it interferes with the daily life, it;s time to have it evaluated and treated.
Sources:
Ford, B. and Pfeiffer, R.F. (2005). Pain syndromes and disorders of sensation. In: Parkinson’s Disease and nonmotor dysfunction. R.F. Pfeiffer and I. Bodis-Wollner (Eds). Humana Press, Totowa, New Jersey. Pps. 255-270.
Drake DF, Harkins S, Qutubuddin A (2005) Pain in Parkinson's disease: Pathology to treatment, medication to deep brain stimulation. NeuroReb 20:335 341.
