Pain in Parkinson's Disease

Abstract

Pain and discomfort in Parkinson's disease (MP) are counted as non-motor symptoms and disease have significant impact on the well-being and health satisfaction and the quality of life of PD patients. Although they occur very often, they are still too often not adequately perceived and treated. The reasons for this are, among other things, the diversity of pain and in the challenging differential diagnosis. The disease together under the umbrella term Parkinson's disease pain of various kinds analogous to chronic pain syndrome can, however, distinguish three major subgroups: the neuropathic, nociceptive and mixed pain. The pathophysiology of pain in Parkinson's disease is very complex and still unclear in many respects. New scientific findings indicate a dysfunction of the basal ganglia in the development, transfer and processing of pain. Pain may occur already in the pre-symptomatic phase of the disease and motor symptoms precede, or they occur in analogy to the motor symptoms after diagnosis. There is pain that can be alleviated by optimizing the dopaminergic medication, but also pain, show no response to Levodopa. Pain, which occur associated with motor symptoms and off phases, indicate a necessary optimization of dopaminergic medication. Botulinum toxin has proven effective in the treatment of focal dystonias. Casuistic reports on improvement of pain and dysesthesia after deep brain stimulation. Not Levodopa responsive pain should be fed a multimodal pain therapy, which should in particular take on possible interactions with Parkinson's medications consideration.