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Peripheral pain in Parkinson's disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Peripheral Pain in Parkinson's Disease (PD)

  • prevalence of large-fibre neuropathy in idiopathic PD is estimated at about 16% (1)
  • suggested mechanism is a disruption of peripheral nociception (2)
  • patients with PD have a high prevalence of symmetrical neuropathy, predominantly in sensory axons (2)
  • risk of polyneuropathy has been reported to be increased in patients taking high doses of levodopa (2)
  • main symptoms described include:
    • burning,
    • pins and needles,
    • tingling, and
    • spontaneous pain
    • oral or genital pain is occasionally a symptom (1)
      • orofacial pain is an anatomical classification of pain in patients with PD
        • includes pain when chewing, nocturnal teeth grinding pain, and burning mouth syndrome
        • PD has been associated with a higher rate of bruxism in patients, either asleep or awake (2)
    • radicular pain
      • there is a high incidence of radiculopathy in PD
        • caused by abnormal posture resulting in nerve root compression or dorsal root ganglion impingement
  • 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):
    • suggested first-line therapy options include:
      • local capsaicin
      • tricyclic antidepressants
    • suggested second-line therapy options include:
      • gabapentin
      • anticonvulsants
      • opioids

Clinicians should also consider other common causes of neuropathy in patients with PD presenting with peripheral pain (1)


  • 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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