Discomfort and Pain related to Parkinson’s can be an issue for around 40 per cent of people with Parkinson’s. In some cases, pain may be the principle symptom ahead of others such as those relating to movement.
On the other hand, pain can be caused by any number of things and is not always associated with Parkinson’s so it is important to discuss pain with a doctor. Pain experienced by people with Parkinson’s can partly be a result of rigidity and reduced movement of the joints. If pain is a symptom, many people with Parkinson’s experience it in the back, neck, shoulders and sometimes in the legs. Pain experienced by people with Parkinson’s can be varied. Several common types of pain are discussed here but there are others of course. Again, any pain should be discussed with a general practitioner or other medical professional.
Musculoskeletal pain or muscle and joint pain is very common for people with Parkinson’s. There is a close relationship between Parkinson’s and musculoskeletal disease such as arthritis and osteoporosis. Parkinson’s results in stiffness and reduced frequency and range of movements. Conversely, pain can reduce the motivation to move. Rigidity, abnormalities of posture and lack of spontaneous movement can all contribute to musculoskeletal pain. This type of pain is most commonly felt as an ache around joints, arms and legs. Musculoskeletal pain can be felt in the back affecting posture.
Dyskinetic pain can be a secondary problem to dyskinesias (abnormal involuntary movements) that some people with Parkinson’s experience. Pain from dyskinesias can occur before during or after the dyskinesias. Dyskinetic pain can result from fluctuations in a person’s responses to standard anti-parkinsonian drugs such as levodopa. Note: Dyskinesias are not usually painful unless there is Dystonia.
Dystonia is the abnormal spasm or posturing of body parts such as toes, fingers, ankles or wrists. An example is the feet twisting inwards or toes curling downwards. Dystonia can be painful, rather like a muscle cramp. It can occur in “on or off” phases but usually occurs in “off ” phases.
Muscular cramps can result from rigidity and a reduction in or absence of movement (akinesia).
Radicular pain is a sharp often shock-like shooting pain that radiates or travels down a leg or arm and may involve fingers and toes. It is pain that occurs close to a nerve or a nerve root. People usually describe root pain as a sharp, lightning like sensation that radiates towards the end of a limb. Often radicular pain is a result of a trapped nerve within the spinal cord around the neck or back region.
Neuropathic Pain
People with Parkinson’s can experience naturopathic pain which is often described as a ‘burning’ or cold feeling. It commonly occurs in the feet. A person experiencing this type of pain can find it uncomfortable to have anything touch their feet or legs such as a blanket.
Depression and Pain
Chronic pain can bring about or aggravate depression. People with Parkinson’s have a higher than average risk of developing depression. Sometimes treating the depression helps alleviate the pain although more commonly, existing pain becomes more manageable.
Other
Discomfort in the legs can be troublesome and persistent for people with Parkinson’s. It is sometimes associated with a compulsion to move the legs (akathisia).
Parkinson’s fact sheet
What help is available for pain?
An effective treatment plan worked out with a doctor is an important step towards managing pain. A doctor will be helped a great deal by information from their patient about pain.
To help your doctor help you manage pain, it can be useful to make notes to help answer questions like:
• Where is your pain located?
• What does your pain feel like?
• Does the pain radiate anywhere?
• Do you have pain continuously, or only at certain times?
• Does the pain occur in relation to any particular activity?
• What relieves the pain?
• What makes the pain worse?
• Do your anti-Parkinson’s medications relieve your pain?
• Do you have arthritis?
Types of Treatment
The best treatment for pain will depend on the cause of pain. If the pain is a result of excessive immobility or rigidity, a doctor may prescribe dopaminergic therapy, physical therapy and an exercise programme. Some forms of pain may respond to simple painkillers such as paracetomol.Vigorous massage could help relieve cramp as can the application of local heat with a hot water bottle or wheat bag. Cramps that originate in the muscle can be treated with quinine. The treatment for Dystonia is usually to increase the dopamine medication.
An effective treatment plan worked out with a doctor is an important step towards managing pain. A doctor will be helped a great deal by information from their patient about pain. Physiotherapy can assist with pain management through methods such as manual therapy, the use of heat, cold or some electrical equipment. For back pain posture is important. Parkinson’s can promote flexion or bending and flexion of the back is mechanically stressful and promotes pain. Stretches and appropriate exercises discussed with a medical professional are very useful. Low doses of some antidepressant medication especially tricyclics such as Nortriptyline and Amitriptyline can sometimes help alleviate pain whether or not there is any depression. These medications are most often used to treat neuropathic pain.
Complementary therapies such as Chiropractic or Osteopathy may be an option to help ease pain. A discussion with a doctor is important before trying any complementary therapies. Acupressure and massage can be effective in reducing muscular pain for people with Parkinson’s. Managing pain is important. Pain can seriously affect the quality of life for the person with Parkinson’s and prevent them taking part in activities which would help ease other symptoms or give enjoyment. Unmanaged pain can contribute to poor sleep and worsen other symptoms like depression. It is important that you do not ‘suffer in silence’ so informs your doctor if you are experiencing pain.
Please do not interpret anything in this article as personal medical advice, always check any medical problem with your Doctor.
Further information may be obtained from your local branch of UK Parkinson’s Society
Free phone 0808 800 0303. Email: enquiries@parkinsons.org.uk
References: Pain in Parkinson’s disease, Parkinson’s disease Foundation, 2005.Pain in Parkinson’s, Information Sheet, Parkinson’s disease Society, 2006.Parkinson’s Disease and Pain. Stephen A. King. Geriatric Times, Vol 1, Issue 3, September/October 2000.
