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Musculoskeletal pain in Parkinson's disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Musculoskeletal pain in Parkinson's disease (PD)

  • most common PD pain symptom is pain arising from joints, muscles, and the axial skeleton (1)
  • can present as a prodromal symptom
  • been shown that severity of pain is significantly correlated with the severity of motor complications of PD (2)
  • prevalence of musculoskeletal pain ranges from 40% to 75% in those patients with PD experiencing pain (2)
    • musculoskeletal problems are more common in patients with PD than in elderly without PD
  • PD disease process causes:
    • camptocormia (abnormal forward trunk flexion) and
    • Pisa syndrome (abnormal lateral trunk flexion) accompanied by muscular rigidity
  • leads to abnormal posture and stress on ligaments, facet joints, and soft tissue resulting in pain
  • presentation of musculoskeletal pain presentation is similar to patients without PD; however, subtle postural abnormalities need to be explored clinically as this pain is not amenable to traditional pain relief medication and needs physiotherapeutic interventions and rehabilitation (1)
  • most frequent presentations are
    • low back pain
      • prevalence of low back pain is 50% higher in PD than age-matched controls (1)
      • risk factors for lower back pain include older age, higher depression score, and PD-related factors, including rigidity and poor posture (2)
      • stated that patients with PD that have lower back pain have longer disease durations and higher pain intensities, compared to those without pain (2)
    • shoulder pain
      • unilateral musculoskeletal pain, especially in shoulder arm distribution, is highly specific of PD and may predate rigidity and bradykinesia (1)
    • arthralgias
      • patients with PD that have co-morbid osteoarthritis reported specific pain characteristics (2)
        • more likely to have paraesthesia- and akathisia-related pain, and less likely to have aching pain, compared to patients with PD without osteoarthritis
    • general muscle aches and cramps
  • 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
  • specific management (1):
    • suggested first-line therapy options include:
      • non-steroidal anti inflammatory drugs (NSAIDs)
      • physiotherapy
      • occupational therapy
    • suggested second-line therapy options include:
      • low-dose opioids
      • tricyclic antidepressants

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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