Pain and Parkinson’s Disease
Pain is often a commonly experienced and yet uncommonly discussed symptom associated with Parkinson’s Disease (PD). It has been shown that up to 90% of people with PD experience pain with their diagnosis. However, pain is a very complicated experience and, as we will discuss, can be caused from a multitude of different things. Sometimes it can be difficult to determine the cause of pain symptoms, which makes it harder to treat. However, pain symptoms should not be ignored. A study from 2012 showed that in individuals with PD, pain affected their daily lives more than memory problems or depression. There are many different treatment options and often a multidisciplinary approach is best to combat pain and increase quality of life! Hint: exercise is one of the best medicines here as well.
What is pain?
Pain is not unique to PD and people with PD are not excluded from the pains of aging. Unfortunately, since PD is often seen in older age, it is common to experience normal pains of aging along with pain specific to PD. Pain is not linear cause and effect. Pain is experienced differently by every individual and should be treated as such by your health care team. At a basic level, pain is an unpleasant sensory or emotional experience from the actual or perceived exposure to tissue damage. Pain however, is experienced in the brain and due to this, it can also be influenced by our past experiences, current emotional state and even how rested we are. Check out THIS short video explaining how the brain experiences pain. To understand pain from a neuroscience perspective, check out Lorimer Moseley’s explanation in THIS TedTalk.
Pain in Parkinson’s Disease:
Musculoskeletal Pain: This type of pain is generally the pain that most people experience physically within their bodies. This can be in the muscles, joints, bones, ligaments or tendons. Musculoskeletal pain in PD is generally determined by two main causes: rigidity as a direct cause from the disease itself and decreasing strength which can lead to poor posture causing inflexibility and decreased range of motion. Rigidity is mainly seen in the muscles that flex the joints of the body, most commonly the fronts of the hips, the backs of the knees, and the front of the chest. This can lead to a forward, stooped posture that effects not only your ability to move with ease but can change your balance as well. Other common musculoskeletal injuries that are non-specific to PD but are commonly seen in aging individuals are arthritis, osteoporosis, and disorders of the discs of the spine. These disorders can further complicate pain symptoms seen in PD or be exacerbated by PD. For example, an increasingly stooped posture can further aggravate a herniated disc in the lower spine.
Dystonia/Dyskinesia: Dystonia (abnormal muscle contraction) and dyskinesia (involuntary movement) can be very common in PD. In some cases, dystonia can be small and may present as a musculoskeletal impairment or pain early on in the disease before it progresses to a more obvious symptom. Dystonia patterns seen in PD are common in the flexor muscles of the body but mainly seen in the curling of the toes or turning in of the feet. Dystonia patterns are also more common in medication “off times”. On the other hand, dyskinesia is commonly seen in “on times” of medication and can be a side effect of long term levodopa use.
Neuropathic Pain: this type of pain is specifically related to the nervous system and is usually experienced as numbness, tingling, burning, shooting or sharp pain. Usually this pain is seen in a certain pattern that follows a nerve root but can also present as an entire body part, usually the hand or foot. This type of pain does not respond to common pain medications, therefore it is important to talk to your doctor if you are experiencing this type of pain.
Central Pain: the theories behind central pain in PD are still being explored today. What is known is that many pain pathways cross through the basal ganglia (the area of the brain affected by PD) and therefore people with PD that are experiencing pain may be experiencing it differently. In a study of over 100 individuals with PD, researchers found that people with PD have a decreased pain threshold when compared to individuals their same age, sex and gender.
Multidisciplinary Treatment Approach!
As you can see, there are many reasons why someone with PD may be experiencing pain. The first step should be talking to your movement disorder neurologist to discuss some of the medical aspects that may be associated with pain. From there, exploring alternative approaches to pain management can be helpful!
Medical Therapies: These must be discussed and talked about with your doctor prior to making any changes. If the pain is minor, sometimes over the counter pain medication can be helpful with relatively little side effects. Some pain (such as neuropathic) are treated with daily medications prescribed by your doctor to help manage the symptoms over time. Additionally, using heat/ice can be helpful for musculoskeletal pain as it can help reduce inflammation or relax tight muscles temporarily. If you are experiencing significant increases in muscle tone or have lost a substantial amount of range of motion, your doctor may discuss surgical options or botox injections to help regain the lost mobility and decrease pain.
Rehab Therapies: Physical and Occupational therapists are movement disorder specialists and well trained in assisting people with PD to regain mobility, strength and function. They are also trained in how to safely progress exercise programs to optimize your physical mobility, within a pain free range of motion to get you back to doing what you love! Of course as Physical Therapists, we love exercise! See more below about specific ways exercise can decrease pain and check out our PWR! Moves classes to get started!
Alternative Therapies: other disciplines such as chiropractors, acupuncturists and massage therapists are also trained in assisting with pain disorders. Make sure to get clearance from your doctor to see these professionals to get an accurate diagnosis of the cause of your pain.
Psychosocial Therapies: as mentioned earlier in this post, pain is usually not due to a singular cause. Especially if you are experiencing pain for more than 3 months, there may be multiple causes of your pain or the pain may no longer be physical in nature. Sometimes the pain you are experiencing has a psychological component to it, making it even more important to talk to a health care professional that can help with this part of the pain process. Additionally, research is showing that depression and pain have a strong correlation, meaning treating symptoms of depression may also help with pain symptoms! Psychologist, psychiatrists and social workers are all health care practitioners that may be beneficial to help with this part of the healing process.
How exercise can help!
At NeuroLab 360, we use exercise everyday to help our clients with Parkinson’s Disease. Below are some of the areas we as therapists focus on. Check out our other blog posts (linked below) that dive deep into each of these beneficial practices and get exercising today! We also have a weekly PWR! Moves class every Saturday at 10:30am to help get you started.
Flexibility training: maintaining normal mobility and range of motion can decrease muscle stiffness and enhance normal joint and muscle function.
Strengthening: 2-3 days a week of strength training can help combat the stooped and flexed posture that is commonly seen in PD.
Cardiovascular training: this type of training is multifaceted. It can help decrease depression, increase mobility and causes the production of feel good hormones such as dopamine and serotonin.
PWR! Moves: this exercise approach is specific to PD and targets the 4 main areas that people with PD tend to struggle with the most.
Sources:
Patel, B. Pain. Parkinson’s Foundation. Accessed June 25, 21.
https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Pain
Gilbert, R. Is pain a symptom of Parkinson’s disease. Accessed June 25, 21. https://www.apdaparkinson.org/article/is-pain-a-symptom-of-parkinsons-disease/
Truini A, Frontoni M, Cruccu G. Parkinson’s disease related pain: a review of recent findings. J Neurol. 2013; 260(1): 330-334.
What is pain? Accessed June 25, 21. https://www.painaustralia.org.au/about-pain-old/what-is-pain