Pain management in patients with Parkinson’s disease: challenges and solutions

Figures & data

Table 1 Ranking of the ten most bothersome PD-related symptoms (MS and NMS) in 92 early-onset patients with up to 6 years of disease duration

Rank	Symptom/condition	First choice (%)	Second choice (%)	Third choice (%)
1	Slowness	33	5	13
2	Tremor	30	9	4
3	Stiffness	6	26	11
4	Pain	10	10	5
5	Loss of smell/taste	3	10	3
6	Mood	4	6	4
7	Handwriting	2	3	6
8	Bowel problem	2	3	5
9	Sleep	2	4	1
10	Appetite/weight	0	3	8

Notes: Data adapted from Politis et al⁹

Abbreviations: PD, Parkinson’s disease; MS, motor symptoms; NMS, nonmotor symptoms.

Figure 1 The pathophysiological basis of sensory disturbances in PD, the so-called “pain matrix” with information from different loci, processed in the BG.

Notes: Reprinted from Journal of the Neurological Sciences; 289(1–2); Juri C, Rodriguez-Oroz M, Obeso JA; The pathophysiological basis of sensory disturbances in Parkinson’s disease; 60–65; Copyright 2010, with permission from Elsevier.⁶⁷ The blue dashed line indicates proposed modulator function from STN. Lewy bodies are observed in the vagal nucleuus and locus coeruleus during early stages of PD. These areas contribute to the so-called “pain matrix”. Sensory information of the integrational sensory information in the basal ganglia. Afferent sensory information; different regions of somatosensory cortices converge into striatum where it would interfere with information processing.
Abbreviations: PD, Parkinson’s disease; BG, basal ganglia; GPe, globus pallidus externa, GPi, globus pallidus interna; STN, subthalamic nucleus.

Figure 2 The Pain-O-Meter (Swedish Version).

Table 2 Differentiation of experienced pain

Sex	Durationa of disease, ≤5 years/>5 years	Pain before/after PD diagnosis	Durationb of pain/day, ≤10 h/>10 h	VAS,c ≤5 cm/>5 cm	Pain expressions by participants
					Migrating	Irritating	Worrying	Troublesome	Tiring	Suffocating	RLSd
Females (28)	11/16e	10/17e	20/8	13/14e	13f	5f	3	20f	20	1	5f
Males (16)	9/7	6/10	9/7	9/7	4f	9a	5	5f	9	0	10f

Notes: POM results for PD and chronic pain patients. Data from Skogar et al.⁴⁴

a Lessor more than 5 years.

b Maximal duration (less or more than 10 h) of pain in terms of days 1–5 of the period of pain measurement.

c VAS maximal pain (number of patients reporting less or more than 5 cm) in terms of days 1–5 of the period of pain measurement.

d Yes/No.

e One missing data.

f Statistically significant differences between sex, P≤0.05.

Abbreviations: PD, Parkinson’s disease; h, hours; VAS, visual analog scale; RLS, restless legs syndrome; POM, Pain-O-Meter.

Figure 3 A simplified scheme of pain evaluation and origin in PD.

Abbreviation: PD, Parkinson’s disease.

Figure 4 Visualization of chronic pain localization for males and females.

Note: Adapted from Skogar O, Fall PA, Hallgren G, et al. Parkinson’s disease patients’ subjective descriptions of characteristics of chronic pain, sleeping patterns and health-related quality of life. Neuropsychiatr Dis Treat. 2012;8:435–442. © 2012 Skogar et al, publisher and licensee Dove Medical Press Ltd.⁴⁴

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