Pain in Parkinson's disease: analysis and literature review.

Pain is a common problem faced by Parkinson's disease (PD) patients. Despite its impact and disabling effects pain is still frequently overlooked. In this study we analyze a representative sample of peer reviewed literature for the prevalence and types of pain in PD, the impact and significance of pain in the quality of life of the PD patient and the challenges inherent in the diagnosis and management of pain in PD patients. We compared and analyzed the findings of articles indexed in the PubMed database which looked at symptoms reported by large cohorts of PD patients. These articles all reported the incidence, nature and quality of pain in these patients and described the effects of pain on quality of life and generally were cross-sectional, retrospective or case-control studies, though a major pharmacoepidemiological design study was also analyzed. Results of our analysis showed that the pain was prevalent in 59.77% of PD patients. Five different types of pain were reported by PD patients--dystonia, musculoskeletal pain, nerve/nerve root pain, primary/central pain and according to some, akathisia. Patients who reported pain symptoms were also significantly more likely to report associated depression and a decreased quality of life. Many PD patients also reported poor management of pain and lower analgesic use than would be expected. We further discuss some of the possible approaches toward the development of a treatment algorithm regarding the management of pain in PD. We conclude that pain in is an under-recognized and under treated symptom in PD patients. Effective management of pain in PD patients would significantly improve their quality of life. Our analysis is in line with current thinking that identifies PD is much more of a multisystem disease with non-motor symptoms than previously thought.

Association of pain, Parkinson's disease, and restless legs syndrome.

BACKGROUND: Many patients with restless legs syndrome (RLS) and Parkinson's disease (PD) report having pain, however, the impact of the combination of PD and RLS on pain has not been analyzed extensively. The objective of this study was to explore the potential relationship between RLS and pain in individuals with and without PD, the prevalence of RLS in PD, the prevalence and severity of pain in PD and RLS, and how these measures are related to PD patients and controls. METHODS: The study included 127 PD patients and an equal number of non-PD patients who were assessed for pain and RLS-like symptoms by using RLS diagnostic survey, RLS rating scale and Brief Pain Inventory. RESULTS: The results showed that 21.3% of PD patients had RLS, compared to only 4.7% in the control group, representing a highly significant difference (p<0.005). The frequency of reporting pain was also significantly higher among PD patients with RLS (p<0.005), but not in control group. However, the mean difference in average pain severity was not significantly different between the PD with RLS and non-PD with RLS, nor was the pain level and severity significantly correlated with RLS severity for either group. CONCLUSION: The presence of pain in PD patients may be exacerbated by RLS or in RLS patients, having PD may exacerbate pain.