Pain and Parkinson Disease
More than half of all people with Parkinson disease (PD) report that they experience painful symptoms and various forms of physical discomfort. Their pain symptoms may include aching, stiffness, numbness, and tingling. Pain and discomfort are severe enough for some patients to overshadow other problems caused by the disease. Pain in PD arises from a number of different conditions: (1) musculoskeletal problems caused by poor posture, (2) awkward mechanical function or physical wear and tear, (3) nerve or root pain, (4) dystonia, (5) extreme restlessness, or (6) “central pain.”
Aching muscles and joints are common in PD. Rigidity, lack of spontaneous movement, abnormalities of posture, and awkward mechanical stresses contribute to musculoskeletal pain. Shoulder, hip, back, and neck pain are common complaints. Prolonged immobility often causes contractures in the hands or feet.
Dystonic spasms cause severe, forceful, sustained twisting movements and postures, which are different from flowing, writhing, dyskinetic movements that are not painful. Dystonia in PD affects limbs, the trunk, neck, face, tongue, jaw, and swallowing muscles. Feet and toes may curl painfully. Restlessness, called parkinsonian akathisia, causes an inability to sit still, lie in bed, drive a car, eat at a table, or attend social gatherings.
“Central pain” is part of PD, but is not caused by dystonia or a musculoskeletal problem in and of itself. It involves stabbing, burning, and scalding sensations in the abdomen, chest, mouth, rectum, or genitalia. This type of pain can be quite distressing and more challenging to manage. Those with PD are at a higher risk for developing depression, so it is important for individuals with PD to be assessed for depression as well as pain.
Most persons afflicted with pain in PD do not receive analgesic treatment. Clinicians should ask about and focus on pain management in their care of PD patients.