Management of Pain in Parkinson’s Disease

Sophie, Munazza; Ford, Blair

doi:10.1007/s40263-012-0005-2

Cited by 48 publications

(25 citation statements)

References 112 publications

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“…On the other hand, malfunction of mesolimbic dopaminergic regions, such as the striatum and the VTA, results in excessive pain (Saadé et al, 1997). Notably, several diseases associated with aberrant dopaminergic transmission are comorbid with chronic pain, including Parkinson’s disease (Sophie and Ford, 2012), drug addiction, and major depression (Jarcho et al, 2012). …”

Section: Chronic Pain Modulates the Mesolimbic Circuitrymentioning

confidence: 99%

Modulation of pain, nociception, and analgesia by the brain reward center

2016

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The midbrain dopamine center comprises a key network for reward, salience, motivation, and mood. Evidence from various clinical and preclinical settings points to the midbrain dopamine circuit as an important modulator of pain perception and pain-induced anxiety and depression. This review summarizes recent findings that shed light to the neuroanatomical, electrophysiological and molecular adaptations that chronic pain conditions promote in the mesolimbic dopamine system. Chronic pain states induce changes in neuronal plasticity and functional connectivity in several parts of the brain reward center, including nucleus accumbens, the ventral tegmental area and the prefrontal cortex. Here, we discuss recent findings on the mechanisms involved in the perception of chronic pain, in pain-induced anxiety and depression, as well as in pain-killer addiction vulnerability. Several new studies also show that the mesolimbic dopamine circuit potently modulates responsiveness to opioids and antidepressants used for the treatment of chronic pain. We discuss recent data supporting a role of the brain reward pathway in treatment efficacy and we summarize novel findings on intracellular adaptations in the brain reward circuit under chronic pain states.

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Section: Chronic Pain Modulates the Mesolimbic Circuitrymentioning

confidence: 99%

Modulation of pain, nociception, and analgesia by the brain reward center

2016

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“…Pain associated with dystonia may be related to involuntary muscular contraction and may be best managed with options like botulinum toxin, whereas neuropathic pain may be related to a central dopaminergic deficit and may benefit from therapeutic options targeted at this pathology [32]. In addition, anti-inflammatory medication may help reduce local irritation and opiates may help modulate pain pathways [35]. Once pain in PD patients has been correctly classified according to subtype and separated from pain associated with comorbid conditions (most commonly osteoarthritis but also other conditions such as diabetes and rheumatological conditions), the management of pain with various pharmacological and nonpharmacological therapies may be initiated.…”

Section: Discussionmentioning

confidence: 99%

“…These patients may benefit from nonpharmacological treatment such as stretching exercises, repetitive transcranial magnetic stimulation or cranial electrotherapy stimulation. Repetitive transcranial magnetic stimulation therapy has been shown to be effective in the management of dystonic pain [35]. Dystonic pain may also present as frozen shoulder or as foot dystonia, and analgesia in these presentations may include botulinum toxin injection in addition to optimizing dopaminergic therapy with levodopa or other agents [35,37].…”

Section: Discussionmentioning

confidence: 99%

“…Repetitive transcranial magnetic stimulation therapy has been shown to be effective in the management of dystonic pain [35]. Dystonic pain may also present as frozen shoulder or as foot dystonia, and analgesia in these presentations may include botulinum toxin injection in addition to optimizing dopaminergic therapy with levodopa or other agents [35,37]. IT might be an effective treatment for pain [38,39] or other nonmotor disorders in PD [13,14,15].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Study on Chronic Pain in Parkinson's Disease Patients in Shanghai, China

Pan

Wang

et al. 2014

Integr Med Int

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Background/Aims: Pain in Parkinson's disease (PD) may be more distressing than that in other nonmotor disabilities. The aims of the present study were to assess the prevalence and identify the epidemiological characteristics of PD-related pain among patients with idiopathic PD in Shanghai, China. Methods: A total of 1,058 patients with definite idiopathic PD were investigated using a structure questionnaire in 12 hospitals in Shanghai. The severity of their motor disorders, antiparkinson treatments, and pain-related observations, such as time points for the onset of pain, duration and degree, body localization, external influences, and treatments for pain, were collected for analysis. Results: Approximately 28% (296 subjects) of all PD patients suffered from PD-related pain. Female patients with pain had a higher age level, were older at PD onset, had a higher frequency of pain, a higher frequency of pain before the onset of PD symptoms, a longer duration of pain, and a higher incidence of pain in the early stage compared to male patients. Larger levodopa-equivalent doses, higher frequencies of sleep disorders and/or motor fluctuation, and/or dyskinesia were found in patients with pain compared to patients without pain. The most frequent pain type was musculoskeletal pain followed by dystonia. The male group had a much shorter pain duration than the female group. The patients experienced more pain before taking antiparkinson drugs compared to after treatment. Conclusion: Chronic PD-related pain is a frequent complaint and complex in PD. The challenge of managing pain in PD patients will hopefully someday result in specific and effective treatment strategies. i 2014 S. Karger AG, Basel

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“…Dystonic focal pain may respond to botulinum toxin injections (103). Other treatments including NSAIDs, opiates, antidepressants, and rTMS have all been found effective in PD pain (104).…”

Section: Painmentioning

confidence: 99%

Treatment of advanced Parkinson's disease

Giugni

Okun

2014

Current Opinion in Neurology

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Purpose of the review Later stage Parkinson’s disease (PD), sometimes referred to as advanced disease, has been characterized by motor complication, as well as by the potential emergence non-levodopa responsive motor and non-motor symptoms. The management of advanced stage PD can be complex. This review summarizes the currently available treatment strategies for addressing advanced PD. Recent findings We will discuss the latest pharmacological strategies (e.g. inhibitors of dopamine-metabolizing enzymes, dopamine agonists and extended release dopamine formulations) for addressing motor dysfunction. We will summarize the risks and benefits of current invasive treatments. Finally, we will address the current evidence supporting the treatment of non-motor symptoms in the advanced PD patient. We will conclude by detailing the potential non-pharmacological and multidisciplinary approaches for advanced stage PD. Summary The optimization of levodopa is in most cases the most powerful therapeutic option available, however medication optimization requires an advanced understanding of PD. Failure of conventional pharmacotherapy, should precipitate a discussion of the potential risks and benefits of more invasive treatments. Currently, there are no comparative studies of invasive treatment. Among the invasive treatments, deep brain stimulation has the largest amount of existing evidence, but also has the highest individual per patient risk. Non-motor symptoms will affect quality of life more than the motor PD symptoms, and these non-motor symptoms should be aggressively treated. Many advanced PD patients will likely benefit from multi- and interdisciplinary PD teams with multiple professionals collaborating to develop a collective and tailored strategy for an individual patient.

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Management of Pain in Parkinson’s Disease

Cited by 48 publications

References 112 publications

Modulation of pain, nociception, and analgesia by the brain reward center

Modulation of pain, nociception, and analgesia by the brain reward center

Clinical Study on Chronic Pain in Parkinson's Disease Patients in Shanghai, China

Treatment of advanced Parkinson's disease

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