Management of Pain in Parkinson’s Disease

Buhmann, Carsten; Kassubek, Jan; Jost, Wolfgang H.

doi:10.3233/jpd-202069

Cited by 60 publications

(47 citation statements)

References 107 publications

(186 reference statements)

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“…In another randomized placebo-controlled trial, injection of incobotulinumtoxinA with 100 units into either the flexor digitorum brevis or flexor digitorum longus was effective in reducing pain associated with plantar flexion of toe dystonia [ 49 ]. Finally, as discussed previously, BoNT can help with painful myotonus or spasms in the esophagus, pylorus, anal sphincter, and detrustor muscle [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Applications of Botulinum Neurotoxin for Autonomic Symptoms in Parkinson’s Disease: An Updated Review

Mitchell

Sidiropoulos

2021

Toxins

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Parkinson’s disease is the most common age-related motoric neurodegenerative disease. In addition to the cardinal motor symptoms of tremor, rigidity, bradykinesia, and postural instability, there are numerous non-motor symptoms as well. Among the non-motor symptoms, autonomic nervous system dysfunction is common. Autonomic symptoms associated with Parkinson’s disease include sialorrhea, hyperhidrosis, gastrointestinal dysfunction, and urinary dysfunction. Botulinum neurotoxin has been shown to potentially improve these autonomic symptoms. In this review, the varied uses of botulinum neurotoxin for autonomic dysfunction in Parkinson’s disease are discussed. This review also includes discussion of some additional indications for the use of botulinum neurotoxin in Parkinson’s disease, including pain.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Applications of Botulinum Neurotoxin for Autonomic Symptoms in Parkinson’s Disease: An Updated Review

Mitchell

Sidiropoulos

2021

Toxins

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“…This indicates that physicians need to pay more attention to the occurrence of non-motor symptoms, especially pain, which was the sensory impairment most commonly reported by patients, exceeding mentions of constipation, mood disorder or unexpected olfactory impairment. A previous study showed that pain was ranked highly as a troublesome symptom in all stages of the disease and was particularly frequent in early-stage PD (18,19). Separating PD-related pain from pain of other origins is an important challenge due to a phenomenon known as "many syndromes under the same umbrella" (18); ∼40% of patients may not report this complaint in routine visits to a physician (20).…”

Section: Discussionmentioning

confidence: 99%

Findings in Chinese Patients With Parkinson's Disease: A Content Analysis From the SML Study

Qian

Zhang

et al. 2021

Front. Psychiatry

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Social media listening (SML) is a new process for obtaining information from social media platforms to generate insights into users' experiences and has been used to analyze discussions about a multitude of diseases. To understand Parkinson's disease patients' unmet needs and optimize communication between doctors and patients, social media listening was performed to investigate concerns in Chinese patients. A comprehensive search of publicly available social media platforms with Chinese-language content posted between January 2005 and April 2019 in mainland China was performed using defined Parkinson's disease-related terms. After multiple steps of machine screening were performed, a series of posts were derived. The content was summarized and classified manually to analyze and map psychological insights, and descriptive statistics were applied to aggregate findings. A total of 101,899 patient-related posts formed the basis of this study. The topics mainly focused on motor symptoms (n = 54,983), choice of pharmaceutical drugs (n = 45,203) and non-motor symptoms (n = 44,855). The most common symptoms mentioned were tremor (54.5%), pain (22.9%), and rigidity (22.1%). Psychological burden (51%) and work/social burden (48%) were the most concerning burdens for patients and their families. The compound levodopa (43%) and dopamine agonists (23%) were the most common options for the patients, while concerns about new-generation anti-Parkinson's disease medication increased. The portraits of patients suggested varying characteristics across different periods and advocate for personalized service from doctors. In the management of patients, it is imperative to plan individualized therapy and education strategies as well as strategies for social support.

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“…Monoamine oxidase inhibitors (MAOI-B), such as selegiline, may also be beneficial in treating PD related pain. A post-hoc analysis revealed that safinamide reduced the number of concomitant pain treatments that PD patients relied on, and also the scores of the “bodily discomfort” domain of the Parkinson’s Disease Questionnaire-39 [ 84 , 94 , 95 ].…”

Section: Treatment Of Chronic Pain In Parkinson’s Diseasementioning

confidence: 99%

“…As with the dopaminergic agents, there is a paucity of literature examining other pharmacologic agents in the treatment of chronic pain in PD. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac were reported by PD patients to be the medication most frequently used to treat their pain [ 94 ]. The use of these drugs has not been linked to constipation.…”

Section: Treatment Of Chronic Pain In Parkinson’s Diseasementioning

confidence: 99%

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Chronic Pain Treatment Strategies in Parkinson’s Disease

Edinoff

Sathivadivel

McBride

et al. 2020

Neurology International

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Neurological disorders, including Parkinson’s disease (PD), have increased in prevalence and are expected to further increase in the coming decades. In this regard, PD affects around 3% of the population by age 65 and up to 5% of people over the age of 85. PD is a widely described, physically and mentally disabling neurodegenerative disorder. One symptom often poorly recognized and under-treated by health care providers despite being reported as the most common non-motor symptom is the finding of chronic pain. Compared to the general population of similar age, PD patients suffer from a significantly higher level and prevalence of pain. The most common form of pain reported by Parkinson’s patients is of musculoskeletal origin. One of the most used combination drugs for PD is Levodopa-Carbidopa, a dopamine precursor that is converted to dopamine by the action of a naturally occurring enzyme called DOPA decarboxylase. Pramipexole, a D2 dopamine agonist, and apomorphine, a dopamine agonist, and Rotigotine, a dopamine receptor agonist, have showed efficacy on PD-associated pain. Other treatments that have shown efficacy in treating pain of diverse etiologies are acetaminophen, Nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenase-2 (COX-2) inhibitors. Opioids and opioid-like medications such as oxycodone, morphine, tramadol, and codeine are also commonly employed in treatment of chronic pain in PD. Other opioid related medications such as Tapentadol, a central-acting oral analgesic with combined opioid and noradrenergic properties, and Targinact, a combination of the opioid agonist oxycodone and the opioid antagonist naloxone have shown improvement in pain. Anticonvulsants such as gabapentin, pregabalin, lamotrigine, carbamazepine and tricyclic antidepressants (TCAs) can be trialed when attempting to manage chronic pain in PD. The selective serotonin and noradrenaline reuptake inhibitors (SNRIs) also possess pain relieving and antidepressant properties, but carry less of the risk of anticholinergic side effects seen in TCAs. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been shown in multiple studies to be effective against various types of PD associated pain symptoms. Massage therapy (MT) is one of the most common forms of complementary and alternative medicine. Studies have shown that pressure applied during MT may stimulate vagal activity, promoting reduced anxiety and pain, as well as increasing levels of serotonin. In a survey study of PD patients, rehabilitative therapy and physical therapy were rated as the most effective for pain reduction, though with only temporary relief but these studies were uncontrolled. Yoga has been studied for patients with a wide array of neurological disorders. In summary, PD pathology is thought to have a modulating effect on pain sensation, which could amplify pain. This could help explain a portion of the higher incidence of chronic pain felt by PD patients. A treatment plan can be devised that may include dopaminergic agents, acetaminophen, NSAIDs, opioids, antidepressants, physical therapies, DBS and other options discussed in this review. A thorough assessment of patient history and physical examination should be made in patients with PD so chronic pain may be managed effectively.

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Management of Pain in Parkinson’s Disease

Cited by 60 publications

References 107 publications

Therapeutic Applications of Botulinum Neurotoxin for Autonomic Symptoms in Parkinson’s Disease: An Updated Review

Therapeutic Applications of Botulinum Neurotoxin for Autonomic Symptoms in Parkinson’s Disease: An Updated Review

Findings in Chinese Patients With Parkinson's Disease: A Content Analysis From the SML Study

Chronic Pain Treatment Strategies in Parkinson’s Disease

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