Central pain syndrome in Parkinson's disease

Central pain syndrome in Parkinson's disease

Central pain syndrome

• is attributed to defective pain processing and depletion of dopamine in the brain (1)
  • central causes include a lower pain threshold, altered pain processing, and motor/non-motor fluctuations (2)
• clinical presentation is heterogeneous and vague
  • can present as bizarre visceral sensations with elements of dysautonomia such as:
    • abdominal cramps or hot flushes,
    • as formication (a sense of insects crawling over the skin),
    • or as increased responsiveness to mild or non-painful stimuli
  • because of symptom vagueness and overlap with other types of pain, patients often find it difficult to volunteer symptom information
  • been noted that there is a higher frequency of central pain in patients with advanced-stage of Parkinson's disease compared to those with early-stage Parkinson's disease (2)
  • 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):
    • first line options include:
      • tricyclic antidepressants
      • weak opioids
    • second line options include:
      • strong opioids
      • anticonvulsants

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.