Parkinson’s disease (PD) is a
neurodegenerative disorder that affects predominately dopamine-producing
(“dopaminergic”) neurons in a specific area of the brain called substantia
nigra. Symptoms generally develop slowly over years. PD is widely
recognized by its motor characteristics; however there are well-described
non-motor manifestations such as dementia, major depression, sleep disorder,
autonomic dysfunction, and pain. In fact, the estimated prevalence of pain in
PD varies widely and can be up to 85% of patients. This may largely reflect
musculoskeletal and arthralgias secondary to dystonia. However, it is observed
that pain persists in regions unaffected by dystonia, which may involve a
commonly overlooked and poorly understood etiology of central pain.
The objective of
this study was to discuss a case report of central pain in Parkinson’s disease
in an outpatient setting. A 67-year-old-male patient with Parkinson’s disease
presented with gradual onset of right upper and lower extremity pain and
weakness for 6 months. His pain was increased with emotional stress and was
progressively exacerbated as he developed a tremor, rigidity, and bradykinesia
within his right hemi body. Trials of multiple
analgesics, including short acting opioids and acetaminophen were not
successful. His pain only mildly responded to NSAID therapy. His consulting
neurologist initiated levodopa-carbidopa at 25/100mg every 3 hours for several
months. The intensity of the burning pain in his right upper and lower
extremity was decreased by the next clinic visit, and he was maintained on the
same dosing schedule for one year. He was later trialed on scheduled pregabalin
and tramadol with favorable results. He was thus encouraged to continue his
medications, and during a subsequent visit, his pain had significantly
resolved. Additionally, his rigidity improved, and he no longer had evidence of
a tremor during his following clinic visits.
In summary, this
case illustrates the need for a multidisciplinary approach to better care for
Parkinson’s disease patients with central pain, and further studies to identify
the pathophysiologic mechanism are needed.
Article by Roger
S. Moon, et al, from Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Full access: http://mrw.so/4HC8W1
Image by raheel MEMON, from Flickr-cc.
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