The challenge of pain in the pharmacological management of Parkinson’s disease

ABSTRACT

Introduction: Pain is a common symptom in Parkinson’s disease (PD), impairing quality of life. The clinical appearance and the underlying etiologies are diverse. Different subtypes of pain may occur, with musculoskeletal pain considered to be the most frequent. Often there is also a combination of different causes of pain. There is a lack of controlled studies addressing pain therapy in PD.

Areas covered: In this review the authors analyzed the currently available data, taking into account the available publications in the databases, especially PubMed. The authors further provided their expert perspectives on the challenges of treating pain in PD patients.

Expert opinion: There is both nociceptive and neuropathic pain and in patients with PD, some PD-related pain and some unrelated. Diagnosis requires a thorough and differentiated history and examination, and targeted diagnostics. Therapeutically, many drugs are used, but the data is unfortunately limited and not specific. Medications used include Parkinson-related, mainly dopaminergic drugs, as well as opioids and non-opioid analgetics, anticonvulsives, antidepressants, and more recently cannabinoids. Currently, therapy is performed nonspecifically, without taking into account the special requirements of PD. Unfortunately, in many cases, pain is resistant to these therapies. In the future, both diagnostic and therapeutic efforts should be made to address this issue.

KEYWORDS:

• Parkinson’s disease
• pain
• pain therapy
• analgetics
• opioids

Article highlights

• Pain in PD is a frequent and life-impairing non-motor symptom in PD but not in the focus of diagnostic and therapy yet.

• The clinical appearance and the underlying etiologies of pain in PD are diverse and there is both nociceptive and neuropathic pain with PD-related and PD-unrelated pain.

• Because there is a lack of controlled studies, addressing pain therapy in PD therapeutical strategies should consider the underlying etiology of pain in the individual patient.

• Often, an interdisciplinary approach makes sense, supported by complementary therapy.

• A staged procedure has to be considered, favoring non-opioid analgesics NSAIDs before using low or high-potent opioids for the musculoskeletal pain, and anticonvulsives or antidepressants for neuropathic pain.

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Declaration of interest

W Jost is both a speaker and advisor for AbbVie, Allergan, Bial, Desitin, Ipsen, Merz, UCB and Zambon while C Buhmann is both a speaker and advisor for Bial, Desitin, Grunenthal, Novartis, TAD-Pharma, UCB, and Zambon. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

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Funding

This manuscript has not been funded.