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Central pain syndrome in Parkinson's disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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.

 


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