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Pain

People who live with Parkinson’s disease feel pain more acutely than others. Muscle stiffness, immobility, poor postures and fluctuations in the effectiveness of treatment are among the most common causes of pain. 

Infographics: 50% of people with Parkinson’s disease suffer from pain. 

The pain suffered affects a wide variety of areas, has very different causes and requires different treatments.

The pain associated with Parkinson’s disease can have many origins. 

The poor postures associated with Parkinson’s disease, such as the forward bending of the spine, or osteoarthritis, cause compression of the peripheral nerves going to the leg. The pain is most often localized in the buttock, the front side of the leg below the knee, or in the back. The pain is felt as burning, throbbing, or like a stab. It may be accompanied by tingling or numbness. These compressions of the nerves can also affect the neck, arms and fingers. Aging and Parkinson’s disease also contribute to the development of these pains.

The degeneration of areas in the brain also causes pain which is more often diffuse and perceived as a burning, cold, or itching sensation. These pains can affect a limb, part of the body or the face, without specific limits. These pains are like hallucinations. They are fabrications of the brain, but extremely painful.

Sometimes, the pain is visceral in origin. They seem to be associated with poor functioning of internal organs. These could be, for example, abdominal spasms, feelings of respiratory blockage, or pain in the mouth. These pains are common in people who have disturbances such as orthostatic hypotension, urinary problems or constipation.

Musculoskeletal pain affects, as the name suggests, bones, muscles and tendons. They are felt as sensations of stiffness, cramps, spasms of muscle tension occurring most often in the morning.

Dystonia is an abnormal twisting of a part of the body leading to its deformation, abnormal postures, and severe pain. It mainly affects the neck, the hands, the foot and the spine. Dystonia of the foot that occurs in the morning is particularly painful.

People living with Parkinson’s disease feel pain more acutely than others, especially on the side most affected by the disease. The perception of the level of pain is regulated by several regions of the brain which filter the arrival of painful sensations. 

One of these important pain filters is the black substance, which is primarily affected by Parkinson’s disease. Thus, the sensation of pain is increased.

Taking antiparkinsonian drugs can reduce certain types of pain, notably by reducing the extent of musculoskeletal deformities while increasing the pain threshold.

Your neurologist, by questioning you, will determine the cause of your pain. To help them better understand your pain, it is helpful to write down some details when you feel it: 

  • What kind of pain is it?
  • Where is the pain in your body?
  • When do you feel it and how often?
  • How long have you been feeling this pain?
  • Does the pain get worse over time?
  • Does any particular movement cause the pain?
  • Does the effectiveness of your medications affect the pain?

Muscle stretching, massages, and hot baths can help relieve some pain. 

A follow-up in physiotherapy can be beneficial for the pains associated with bad postures that compress the peripheral nerves.

Taking acetaminophen (TylenolⓇ), up to 3g per day, may reduce musculoskeletal pain. Taking over-the-counter anti-inflammatory drugs (AdvilⓇ) is contraindicated in the long term. In any case, these drugs available in drug stores are not effective against pain of central origin.

Getting the most from your Parkinson’s treatment is one of the keys to good pain management. End-of-dose dystonia, central and visceral neuropathic pain as well as joint pain are particularly sensitive.

Some antidepressants help relieve chronic pain and are indicated in patients with symptoms of severe anxiety or depression. They can, however, cause embarrassing side effects such as confusion, hallucinations, constipation, or urinary retention.

Some pains associated with dystonia can be relieved with botulinum toxin injections. 

Deep brain stimulation makes it possible to increase the pain perception threshold over time, to reduce pain of central origin and musculoskeletal pain. However, it is ineffective against the pain associated with compressions of the peripheral nerves.

The pain associated with stiffness and poor posture tends to increase with the progression of the disease. The same goes for muscle and joint pain. Radiating pain caused by a pinched nerve usually remains stable.

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