Chronic pain in Parkinson's disease: The cross‐sectional French DoPaMiP survey

Abstract

Pain is a frequent, but poorly studied symptom of Parkinson's disease (PD). DoPaMiP survey aimed to assess the prevalence of chronic pain in PD, to describe PD patients with chronic pain, and to record analgesic consumption. About 450 parkinsonian patients underwent structured standardized clinical examination and completed self-reported questionnaires in a cross sectional survey. Pains related or unrelated to PD were identified according to predefined criteria. About 98 patients with other chronic disorders than PD were examined to assess if pain was more frequent in PD than in this population. Two thirds parkinsonian patients (278 of 450) had chronic pain. Twenty-five patients with non-chronic pain (<3-month duration) were excluded from subsequent analysis. Twenty six percent (111 of 425) parkinsonian patients had pain unrelated to PD ("non-PD-pain", caused mainly by osteoarthritis), while 39.3% (167 of 425) had chronic pain related to PD ("PD-pain"). In this last group, PD was the sole cause of pain in 103 and indirectly aggravated pain of another origin (mainly osteoarthritis) in 64. Parkinsonian patients with "PD-pain" were younger at PD onset, had more motor complications, more severe depressive symptoms than those without pain or with "non-PD pain." "PD-pain" was more intense (P = 0.03), but was less frequently reported to doctors (P = 0.02), and was associated with less frequent analgesic consumption than "non-PD-pain." Pain was twice more frequent in PD patients than in patients without PD after adjustment for osteo-articular comorbidities (OR = 1.9; 95% CI 1.2-3.2). Chronic pain is frequent but underreported in PD. Awareness of this problem should be increased and the assessment of analgesic strategies improved.

Recruitment rate, feasibility and safety of power training in individuals with Parkinson's disease: a proof-of-concept study

“…It has been suggested that strength exercises with low loads are less likely to aggravate the symptoms of illnesses such as osteoarthritis [OA] in older adults 33 . However, it is necessary to consider the possibility that training exacerbates pain and the fact that OA has been singled out as one of the most frequent causes of chronic pain in patients with PD and may be exacerbated by the disease 34 . Therefore, a careful joint assessment is recommended prior to the start of the exercise program as well as greater care during its execution, specifically with range of motion exercises, in order to avoid the worsening of pain.…”

Prevalence, Classification, and Etiology of Pain in Parkinson's Disease: Association between Parkinson's Disease and Fibromyalgia or Chronic Widespread Pain

“…Two studies showed that the frequency of pain in PD patients was not significantly greater than that in controls (Quittenbaum and Grahn 2004;Chaudhuri et al 2006). On the other hand, 7 studies showed that the frequency of pain in PD patients was significantly greater than that in controls (Riley et al 1989;Clifford et al 1998;Etchepare et al 2006;Broetz et al 2007;Defazio et al 2008;Negre-Pages et al 2008;Beiske et al 2009;Ehrt et al 2009) (Table 1). Because there are more of the latter studies, including 2 extensive studies (Defazio et al 2008;Negre-Pages et al 2008), we think that the frequency of pain in PD patients is significantly greater than that in controls.…”

“…PD is characterized by resting tremor, slow and decreased movement (hypokinesia and akinesia), rigidity, postural instability, problems with gait, and impaired coordination. In addition to these motor symptoms, patients with PD often suffer from nonmotor symptoms, including severe pain (Riley et al 1989;Clifford et al 1998;Etchepare et al 2006;Broetz et al 2007;Defazio et al 2008;Negre-Pages et al 2008;Beiske et al 2009). …”

Pain perception in Parkinson’s disease: A systematic review and meta-analysis of experimental studies

“…A recent systematic review indicated a mean pain prevalence of 68% in PD patients [6], with another study finding that chronic pain complaints, especially musculoskeletal pain, were twice as likely and reported as twice as intense in PD patients compared to age-matched controls with other chronic disorders [42]. Pain often appears early in the development of PD and may be present years before clinical diagnosis [49].…”