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      Management of Pain in Parkinson’s Disease

      review-article
      Author(s): a , * , b , c
      Editor(s): ,
      Publication date (Electronic, preprint):
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Journal of Parkinson's Disease
      Publisher: IOS Press
      Keywords: Parkinson’s disease, pain, therapy, analgetics, pathophysiology, non-motor symptoms

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          Abstract

          Pain is a very frequent symptom with influence on the quality of life in Parkinson’s disease (PD), but is still underdiagnosed and commonly treated only unsystematically. Pain etiology and pain character are often complex and multi-causal, and data regarding treatment recommendations are limited. Pain can be primarily related to PD but frequently it is associated with secondary diseases, such as arthrosis of the spine or joints. However, even basically PD-unrelated pain often is amplified by motor- or non-motor PD symptoms, such as akinesia or depression. Beyond an optimization of anti-parkinsonian treatment, additional pain treatment strategies are usually needed to properly address pain in PD. A careful pain history and diagnostic work-up is essential to rate the underlying pain pathophysiology and to develop a targeted therapeutic concept. This review gives an overview on how pain is treated in PD patients and how patients assess the effectiveness of these therapies; here, the manuscript focuses on pathophysiology-driven suggestions for a multimodal pain management in clinical practice.

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          Most cited references106

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          A randomized trial of deep-brain stimulation for Parkinson's disease.

          Günther Deuschl, Carmen Schade-Brittinger, Paul Krack … (2006)
          Neurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson's disease. We compared this treatment plus medication with medical management. In this randomized-pairs trial, we enrolled 156 patients with advanced Parkinson's disease and severe motor symptoms. The primary end points were the changes from baseline to six months in the quality of life, as assessed by the Parkinson's Disease Questionnaire (PDQ-39), and the severity of symptoms without medication, according to the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III). Pairwise comparisons showed that neurostimulation, as compared with medication alone, caused greater improvements from baseline to six months in the PDQ-39 (50 of 78 pairs, P=0.02) and the UPDRS-III (55 of 78, P<0.001), with mean improvements of 9.5 and 19.6 points, respectively. Neurostimulation resulted in improvements of 24 to 38 percent in the PDQ-39 subscales for mobility, activities of daily living, emotional well-being, stigma, and bodily discomfort. Serious adverse events were more common with neurostimulation than with medication alone (13 percent vs. 4 percent, P<0.04) and included a fatal intracerebral hemorrhage. The overall frequency of adverse events was higher in the medication group (64 percent vs. 50 percent, P=0.08). In this six-month study of patients under 75 years of age with severe motor complications of Parkinson's disease, neurostimulation of the subthalamic nucleus was more effective than medical management alone. (ClinicalTrials.gov number, NCT00196911 [ClinicalTrials.gov].). Copyright 2006 Massachusetts Medical Society.
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            The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease.

            Paolo Barone, Angelo Antonini, Carlo Colosimo … (2009)
            We performed a multicenter survey using a semistructured interview in 1,072 consecutive patients with Parkinson's disease (PD) enrolled during 12 months in 55 Italian centers to assess the prevalence of nonmotor symptoms (NMSs), their association with cognitive impairment, and the impact on patients' quality of life (QoL). We found that 98.6% of patients with PD reported the presence of NMSs. The most common were as follows: fatigue (58%), anxiety (56%), leg pain (38%), insomnia (37%), urgency and nocturia (35%), drooling of saliva and difficulties in maintaining concentration (31%). The mean number of NMS per patient was 7.8 (range, 0-32). NMS in the psychiatric domain were the most frequent (67%). Frequency of NMS increased along with the disease duration and severity. Patients with cognitive impairment reported more frequently apathy, attention/memory deficit, and psychiatric symptoms. Apathy was the symptom associated with worse PDQ-39 score but also presence of fatigue, attention/memory, and psychiatric symptoms had a negative impact on QoL. These findings further support a key role for NMS in the clinical frame of PD and the need to address them specifically in clinical trials using dedicated scales. 2009 Movement Disorder Society.
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              EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision.

              N Attal, G Cruccu, R. Baron … (2010)
              This second European Federation of Neurological Societies Task Force aimed at updating the existing evidence about the pharmacological treatment of neuropathic pain since 2005. Studies were identified using the Cochrane Database and Medline. Trials were classified according to the aetiological condition. All class I and II randomized controlled trials (RCTs) were assessed; lower class studies were considered only in conditions that had no top-level studies. Treatments administered using repeated or single administrations were considered, provided they are feasible in an outpatient setting. Most large RCTs included patients with diabetic polyneuropathies and post-herpetic neuralgia, while an increasing number of smaller studies explored other conditions. Drugs generally have similar efficacy in various conditions, except in trigeminal neuralgia, chronic radiculopathy and HIV neuropathy, with level A evidence in support of tricyclic antidepressants (TCA), pregabalin, gabapentin, tramadol and opioids (in various conditions), duloxetine, venlafaxine, topical lidocaine and capsaicin patches (in restricted conditions). Combination therapy appears useful for TCA-gabapentin and gabapentin-opioids (level A). There are still too few large-scale comparative studies. For future trials, we recommend to assess comorbidities, quality of life, symptoms and signs with standardized tools and attempt to better define responder profiles to specific drug treatments.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Parkinsons Dis
                Journal ID (iso-abbrev): J Parkinsons Dis
                Journal ID (publisher-id): JPD
                Title: Journal of Parkinson's Disease
                Publisher: IOS Press (Nieuwe Hemweg 6B, 1013 BG Amsterdam, The Netherlands )
                ISSN (Print): 1877-7171
                ISSN (Electronic): 1877-718X
                Publication date (Electronic, preprint): 15 June 2020
                Publication date (Electronic, pub): 01 September 2020
                Publication date (Electronic, collection): 2020
                Volume: 10
                Issue: Suppl 1 , Special Issue: Clinical management of Parkinson’s disease: Essentials and new developments
                Pages: S37-S48
                Affiliations
                [a ]Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
                [b ]Department of Neurology, University of Ulm , Ulm, Germany
                [c ]Parkinson-Klinik Ortenau, Wolfach, Germany
                Author notes
                [* ]Correspondence to: Prof. Dr. Carsten Buhmann, Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 52771; Fax: +49 40 7410 45780; E-mail: buhmann@ 123456uke.de .
                Article
                Publisher ID: JPD202069
                DOI: 10.3233/JPD-202069
                PMC ID: 7592654
                PubMed ID: 32568113
                SO-VID: 796344b5-2337-4894-a31b-1b298f3d9b4b
                Copyright © © 2020 – IOS Press and the authors. All rights reserved
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 18 May 2020
                Categories
                Subject: Review

                Keywords: parkinson’s disease,pain,therapy,analgetics,pathophysiology,non-motor symptoms
                Data availability:
                Keywords: parkinson’s disease, pain, therapy, analgetics, pathophysiology, non-motor symptoms

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