Peripheral pain in Parkinson's disease

Peripheral Pain in Parkinson's Disease (PD)

• prevalence of large-fibre neuropathy in idiopathic PD is estimated at about 16% (1)
• suggested mechanism is a disruption of peripheral nociception (2)
• patients with PD have a high prevalence of symmetrical neuropathy, predominantly in sensory axons (2)
• risk of polyneuropathy has been reported to be increased in patients taking high doses of levodopa (2)
• main symptoms described include:
  • burning,
  • pins and needles,
  • tingling, and
  • spontaneous pain
  • oral or genital pain is occasionally a symptom (1)
    • orofacial pain is an anatomical classification of pain in patients with PD
      • includes pain when chewing, nocturnal teeth grinding pain, and burning mouth syndrome
      • PD has been associated with a higher rate of bruxism in patients, either asleep or awake (2)
  • radicular pain
    • there is a high incidence of radiculopathy in PD
      • caused by abnormal posture resulting in nerve root compression or dorsal root ganglion impingement
• non-pharmacological management:
  • multidisciplinary approach to care involving specialist nurses, physiotherapy, occupational therapy, and social prescribing is highly recommended
  • a balanced diet
    • can address pains related to constipation, decreased bone density, and low mood
    • food affects levodopa absorption resulting in steady state levels of dopamine, which may alleviate some symptoms
  • early recognition and treatment of depression also helps in pain modulation
  • exercise therapy, involving correct posture and muscle strengthening, improves musculoskeletal pain and quality of life
  • acupuncture and alternative therapies such as mindfulness or meditation may be of value in motivated patients
• pharmacological management (1):
  • suggested first-line therapy options include:
    • local capsaicin
    • tricyclic antidepressants
  • suggested second-line therapy options include:
    • gabapentin
    • anticonvulsants
    • opioids

Clinicians should also consider other common causes of neuropathy in patients with PD presenting with peripheral pain (1)

Reference:

• Khan AZ et al. Pain syndromes in Parkinson’s disease: an update for general practice. BJGP 2024; 74 (739): 90-92.
• Tai YC, Lin CH. An overview of pain in Parkinson's disease. Clin Park Relat Disord. 2019 Nov 28;2:1-8.