April 2012
Ha AD, Jankovic J
Pain and other nonmotor symptoms in PD are increasingly recognized as a
major cause of reduced health-related quality of life. Pain in PD may be
categorized into a number of different subtypes, including
musculoskeletal, dystonic, radicular neuropathic, and central pain.
The
onset of pain can vary in relation to motor symptoms, and may precede
the appearance of motor symptoms by several years, or occur after the
diagnosis of PD has been made. Pain in PD is frequently under-recognized
and is often inadequately treated. Levodopa-related dystonia may
respond to manipulation of dopaminergic medication. Dopaminergic therapy
may also improve musculoskeletal pain related to rigidity and akinesia,
as well as akathisia in PD. Botulinum toxin injections can be effective
for treatment of painful focal dystonia. Pain and dysesthesia have been
reported to improve with DBS, in some cases.
Increased understanding of
basal ganglia pathways has provided further insights into the
pathogenesis of pain in PD, but the exact mechanism of pain processing
and modulation remains unclear.
