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Friday, April 18, 2014
Why is it that so many people with Parkinsons Disease post messages in P.D. forums saying they have pain , but we are told there is no pain with P.D. I have pain , and it seems most of us do . Why is this not addressed ?
Any neurologist with experience in treating persons with Parkinson's will readily accept the fact they can have pain. There are different causes for such pain:
1. Dystonic pain: often accociated with cramping, e.g. patients may describe toe curling with pain in the feet or calves. Some neck pain may also be dystonic.
2. Medication related: some patients will have pain similar to the above category either at peak of dose or while withdrawing into the off state.
3. Frozen shoulder: The lack of arm swing seen in PD leads to a stiffness at the level of the shoulder joint that can be very painful.
4. Arthritic pain: in older patients. Not helped by poor posture.
Some ways to help:
1. Optimize medications for PD. Ensuring that the dose fluctuations are minimal by using agonists like Mirapex/Requip?Permax or adding Tasmar may help with obtaining a smoother response.
2. Physical therapy with range of motion excercises help loosen up the frozen shoulder. Such excercises should be part of the Parkinsonian's daily routine.
3. Surgical procedures like pallidotomy can occasionally provide dramatic relief of dystonic pain.
4. Non steroidal analgesics like ibuprofen (Motrin).
Arif Dalvi, MD
College of Medicine
University of Cincinnati