Pain and Parkinson's disease: Current mechanism and management updates

Abstract

The aim of this comprehensive review was to provide an overview of pain in Parkinson's disease (PD) by identifying different clinical features and potential mechanisms, and presenting some data on the evaluation and management of pain in PD. PD is a multifocal degenerative and progressive disease, which could affect the pain process at multiple levels. Pain in PD has a multifactorial aetiology, with a dynamic process based on pain intensity, complexity of symptoms, pain pathophysiology and presence of comorbidities. In fact, pain in PD responds to the concept of multimorphic pain, which can evolve, in relation to the different factors, whether they are linked to disease and its management. Understanding the underlying mechanisms will help in guiding of treatment choices. Providing scientific support useful for clinicians and health professionals involved in management of PD, the aim of this review was to bringing practical suggestions and clinical perspectives on the development of a multimodal approach guided by a multidisciplinary clinical intervention through a combination of pharmacological and rehabilitative approaches, to manage pain to improve the quality of life on individuals with PD.

Pain and the Non-Pharmacological Management of Pain in People with Parkinson’s Disease

“…This review includes literature about nonpharmacological pain management that can be provided by allied health; therefore, deep brain stimulation is not included. For a comprehensive summary of deep brain stimulation for pain management, please refer to the previous reviews [4,5]. Literature for inclusion in this review was identified by each author from personal libraries and resources.…”

“…This type of pain is variable in presentation, can be difficult to localize and fluctuates in intensity [24]. Changes in the central nervous system [4,28,33] may contribute to nociplastic pain in PwP. It is important to note that while these pain types all have their own definitions, in practice many people demonstrate features consistent with more than one pain type and many people with chronic pain will have a nociplastic component [3].…”

“…While a useful and important development, the present review proposes that the mechanistic approach to diagnosing and managing pain in PwP designed by Mylius et al [22] could be further enhanced by viewing all chronic pain experienced by PwP as influenced by the disease process, with PD-related degeneration known to occur in systems involved in the processing and modulation of pain [4,28,33]. It is believed that PD can impact pain processing at multiple levels, starting from the transmission of pain from peripheral structures to higher centers, the reception and interpretation of pain, and also affects the function of several anatomical structures involved in pain mechanisms [4,34]. For example, the characteristic degeneration of dopaminergic neurons in the subcortical structures of the brain such as the striatum and mesolimbic system can lead to the hyperactivation of neurons responsible for pain processing and an increase in pain stimulation signals in the central nervous system [34,35].…”

“…be implemented in the presence of optimal pharmacological management, including optimized doses and schedules of levodopa and/or other antiparkinsonian medications from different classes [4]. The evidence presented regarding the effect of non-pharmacological interventions on pain focuses predominantly on studies that had a stated aim to reduce pain.…”

“…However, there is little research in PwP that has adopted this biopsychosocial approach. Two recent reviews of the non-pharmacological management of pain in PwP [4,5] have provided a comprehensive summary of the literature plus helpful insights into the types of non-pharmacological strategies that have been studied, but have not viewed pain in a biopsychosocial context. Therefore, this narrative review aims to provide new, holistic insights into the non-pharmacological management of pain in PwP by addressing the following aims within a biopsychosocial context:…”