Landscape of pain in Parkinson’s disease: impact of gender differences

ABSTRACT

Background/Aims: Pain is a non-motor symptom of Parkinson’s disease (PD). Few systematic studies have been carried out and there are still no guidelines on pain therapy in PD. Additionally, within the studies that do exist, gender-specific differences in pain perception are often the focus, though no consistent results have to date been obtained. The first main aim of our study was therefore to map pain in the largest PD study group to date, with the second being the analysis of the impact of different pain therapies in PD. The third and main aim was to correlate the obtained results with gender.

Methods: A structured questionnaire with questions focusing on pain was sent to PD patients, with a subsequent statistical analysis correlating the data on pain features and pain therapy with gender.

Results: The study included 1204 female and 1610 male PD patients. Spinal–paravertebral pain emerged as the dominant form of pain. A significant correlation was further demonstrated between gender and pain localization, pain intensity (p-value < 0.05), and pain as impairment to quality of life (p-value < 0.05). Nonsteroidal anti-inflammatory drugs were the painkillers most frequently used by the patients. Aside from non-opioid analgesics (p-value < 0.05), there was no demonstrated significant correlation between pain treatments and gender.

Conclusion: This study found that gender influenced pain perception in the PD patients tested but did not impact the approach to pain therapy.

KEYWORDS:

• Parkinson’s disease
• pain
• pain topography
• pain therapy
• gender
• pain in Parkinson’s disease
• pain and gender
• statistical analysis

Acknowledgments

Special thanks are due to Rick Proemmel, PhD student of the Medizinisches Proteom-Center, Ruhr University in Bochum, for manuscript editing.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Deutsche Parkinson Vereinigung, the Deutsche Parkinson Gesellschaft, the Medical Faculty at Ruhr University in Bochum (FoRUM), the HUPO Brain Proteome Project (HBPP), PURE, a project of Northrhine Westfalia, a federal German state and by de.NBI, a project of the German Federal Ministry of Ecucation and Research [FKZ 031 A 534A].

Notes on contributors

Maria Angela Samis Zella

Maria Angela Samis Zella completed his studies in human medicine at the renowned Universitá degli Studi di Milano in Milan - Italy. There she also carried out his medical doctorate in the Dep. of Neurosurgery and Neurophysiology in neurooncology (Prof. Dr. Lorenzo Bello). Afterwards she trained in the Dep. of Neurosurgery of the Universitá degli Studi di Milano in Milan - Italy and in the Dep. of Neurosurgery of the Heinrich-Heine University in Düsseldorf - Germany and achieved her specialization in neurosurgery and neurooncology. Currently she works in the group of Prof. Dr. Woitalla at the Dep. of Neurology - Parkinson's disease and movement disorders units. Here she is active as a physician and leads her research on Parkinson's disease in collaboration with the “Medizinisches Proteom-Center” (Prof. Dr. Marcus and Dr. May) of the Ruhr University of Bochum - Germany.

Caroline May

Caroline May is leader of the immune proteomics workgroup at the Medical Proteom-Center in Bochum. Her research interests covers the identification of autoantibodies in the context auf neurological autoimmune diseases using protein microarrays as well as mass spectrometry. Moreover, she is interested in analyzing protein changes during healthy ageing in contrast to neurodegenerative diseases.

Thomas Müller

Thomas Müller is Head of the Department of Neurology and is a Consultant in Neurology and Psychiatry at St Joseph Hospital, Berlin, Germany.Prof. Müller studied at the Universities of Bochum, Essen and Munich and gained his licence to practice in 1987. His research interests include use of various functional brain imaging techniques in the diagnosis and evaluation of progression of neurodegenerative diseases and the efficacy of intrathecal steroid application in the treatment of progressive MS. He is also interested in neuropsychological and neuroopthalmologic changes in neurodegenerative diseases. Prof. Müller is on various journal Editorial Boards (i.e. Journal of Neural Neurotransmission) and is the Editor-in-Chief of Degenerative Neurological and Neuromuscular Disease.

Maike Ahrens

Maike Ahrens studied statistics at the University Dortmund, one of the two statistics faculties in Germany. She did her diploma in 2010 with her diploma thesis on sample size estimation in personalized medicine. In 2016 she did her PhD in statistics at the University Dortmund with her PhD thesis on statistical methods for the identification of unknown patient subgroups in high-throughput omics data. With her specially educated, broad expertise in biostatistics and biometrics her activities concern a variety of methods for the analysis and modelling of high-throughput expression data and statistical analyses for medical and biochemical research groups. Her major research interest concerns subgroup detection methods in omics expression data in the area of personalized medicine.

Lars Tönges

Lars Tönges completed his studies in human medicine at the renowned University of Heidelberg. There he also carried out his medical doctorate in the Research Training Group of the Collaborative Research Center 317 in neuroscience and molecular biology (Prof. Dr. H. Monyer). Then he trained as a specialist in neurology at the University Medical Center Göttingen (Prof. Dr. M. Bähr) where he specialized in Parkinson's disease and movement disorders as well as in neurological stroke and acute care medicine. In the group of Prof. Lingor he started own translationally oriented neurobiological projects leading to neuroprotective therapies in neurodegenerative diseases that have already been translated into human clinical studies. In 2015, Prof. Tönges was appointed to a W2 professorship at the Ruhr University Bochum for Clinical and Translational Neuroprotection. There he is active as a senior physician and led the area Parkinson's diseases and movement disorders. In 2017, he received the prestigious Hans-Jörg Weitbrecht Science Prize for Clinical Neurosciences.

Ralf Gold

Ralf Gold was heading the Institute for Multiple Sclerosis Research, University of Goettingen and Gemeinnützige Hertie-Stiftung, until he took the chair of the Department of Neurology, University of Bochum at St. Josef-Spital in August 2006. Here the annual number of MS patients comes to more than 1200 outpatients and 800 inpatients. Prof. Dr. Gold’s main scientific interest is in translational therapies for multiple sclerosis, experimental immunotherapies in the animal models for multiple sclerosis and Guillain-Barré syndrome, and neurobiological disease modulators. He served as leading clinical physician and as principal investigator in a number of controlled therapeutic trials in multiple sclerosis, and is involved in several scientific research programmes and advisory boards. Currently he is past-president of German Neurological Society and is leader of the German MS network panel KKNMS. Together with Prof. Montalban he coordinated the European MS guidelines.  Prof. Dr. Gold is also a member of a number of societies including American Academy for Neurology, European Academy for Neurology and board member of the German Kompetenznetwork Multiple Sclerosis. He has received several scientific awards for his experimental and clinical studies. Also he contributes to several editorial boards. From his scientific work more than 330 original publications and 110 review articles were published, with a h-Index of 62.

Katrin Marcus

Katrin Marcus is Director of the Medizinische Proteom-Center (MPC), Ruhr-University Bochum. From 12/2007- 02/2014 she was Head of the Department of “Functional Proteomics”, Ruhr-University Bochum. Her expertise is in the field of clinical/medical proteomics with a special focus on neurodegeneration and neuromuscular diseases. Constantly, new proteomics methods and strategies are established at the MPC for clinical applications such as the identification of protein biomarkers and understanding of disease mechanisms. 

Dirk Woitalla

Dirk Woitalla completed his studies in human medicine at the renowned Ruhr-University of Bochum. There he also carried out his medical doctorate. Then he trained as a specialist in neurology at the University Medical Center in Bochum (Prof. Dr. R. Gold) where he specialized in Parkinson's disease and movement disorders as well as in neurological stroke and acute care medicine. Prof. Dr. Dirk Woitalla, actually chief at St. Josef Hospital in Essen-Kupferdreh, has been elected in the Board of the Deutsche Parkinson Gesellschaft (DPG). The DPG set the goal of improving the medical care of patients with Parkinson's disease and other correlated neurological diseases and to enable the long-term diagnosis, prevention and cure of these diseases. The election of Prof. Dirk Woitalla honors his scientific work and his commitment to the medical care of Parkinson's disease patients. Parkinson's disease therapy is a focal point of the Department of neurology at the St. Josef Hospital in Essen-Kupferdreh.