Pain and Parkinson's Disease

So pain and Parkinson's disease tend to go hand-in-hand. Yes, Parkinson's disease can, in and of itself, result in pain. There are five common areas or causes, potentially, for Parkinson's to cause pain... 

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Those five areas are musculoskeletal, neuropathic, dystonic, akathisia, and central nervous system.  

Musculoskeletal 

Let's discuss the first one, musculoskeletal. Musculoskeletal refers to muscles in the body, the skeleton, bones, the joints, and the ligaments, the tendons and so forth. There's a lot of things that go into musculoskeletal pain with Parkinson's disease. One of the things that is important to remember is that Parkinson's disease, due to its nature, results in many impairments of the musculoskeletal system. And those are secondary impairments because the primary impairment is neurological, but the secondary impairments can be in the body.

So we tend to see see rigidity and muscle weakness. And of course we mentioned dystonia as one of the types of pain associated with that. We'll get to that in a moment. But it's important to remember that as the trunk becomes more rigid, as posture becomes more stooped, that's due to muscle weakness, and also due to stiffness. So that can result directly in stress to the joints, for example, the joints in the neck, the joints in the upper back, the ligaments surrounding those joints. It can stretch the muscles out too much. And that can cause a lot of discomfort.

Just imagine for a moment, if you were to take your index finger and bend it backwards, just bending it backwards and just keep it there... keep it there... getting a little uncomfortable yet?? So just imagine that you're doing this all day long, and you're doing it day in and day out. That's basically what's happening to the joints in your spine, in your neck, wherever it is in the spine. If there's abnormal stress placed on those joints, that's going to result in ligament stress. Stretching things that shouldn't be stretched and so forth, that causes a lot of pain and discomfort. A lot of times when people are complaining of aches and pains, this is a large part of what you're probably feeling rather than arthritis or joint pain, though that could be present as well. It definitely could be feeling discomfort, fascia restrictions, and ligament strain and so forth.

Neuropathic pain

The second potential cause of pain in PD is neuropathic. Neuropathic basically refers to nerve pain or neuropathy, and Parkinson's disease is very much associated with neuropathies. And neuropathic pain can be extremely painful, anywhere from burning pain, to constant pins and needles. It could be in the hands and/or the feet. In addition, it could also be felt in the entire limb, such as sciatic pain and and the like.

So neuropathies certainly can be an aggravating source of pain because they're difficult to treat at times. One of the things that would be important to consider with neuropathic pain is to discuss that with your movement disorder specialist or your neurologist, especially when it comes to supplements and things that can help, such as vitamins B6 and B12, when it comes to your nerve health with Parkinson's.

Dystonia 

Dystonia refers to involuntary muscle contractions. Parkinson's disease is notorious for causing this in certain individuals, and it's quite painful. If you could just imagine a muscle spasm going off somewhere at random and you can't stop it, no matter how much you stretch it or how much you try to relax it or put heat on it, the spasm continues. It's neurological, therefore typical remedies may not be effective, and it is obviously very painful.

Dystonia can happen in so many different places. As a clinician, I've seen it happen in people's upper body. I've seen it happen where the toes and the feet curl in. I've even seen it in the trunk where people get all twisted up because of it. It's important to note that that is something that's associated with Parkinson's that can not only cause pain, but can also cause deformities with the muscles and the joints.

Akathesia

Next on the list is akathisia. This refers to the inability to become comfortable or the inability to get rid of a sensation. And so, that's essentially the same as restless leg syndrome and things like that. It can be experienced as an "icky" feeling, with jerky movements in the legs. That's also associated with Parkinson's, and there are various causes of restless leg syndrome that I have discussed on our YouTube Channel in a past video.

Central Nervous System

Parkinson's disease tends to affect the central nervous system (CNS). Obviously, because Parkinson's lives in the central nervous system. It is, after all, a brain disorder. But there are other effects of Parkinson's disease besides simply the area which is damaged, which is the neurons of the substantia nigra pars compacta.

The autonomic nervous system is directly impacted by Parkinson's disease, and there are areas of the brain such as the thalamus that directly correlate or directly relate to pain. And so, if any of those areas are affected negatively by Parkinson's, there may be pain basically being generated by the brain itself, and that's really tough to treat. Unfortunately, this can be a reality for some people with Parkinson's disease.

Treatment for Pain in Parkinson's Disease

What are the remedies?

• So number one, of course, is dopamine. Proper dopamine levels help to counteract some of the negative effects that can be associated with Parkinson's disease. We talked about some of the effects that Parkinson's has on the body. With increased dopamine, those effects are lessened. Also, dopamine is a neurotransmitter of pleasure in our brain. So a good feeling, or feeling of well-being, can come from having a higher level of dopamine in our bloodstream and in the brain.
• Number two is Botox, or botulinum toxin. Botox can be often used to paralyze muscles that are problematic when it comes to dystonia or those uncontrolled muscle spasms that can happen in some people with Parkinson's disease. So that's something you can ask your doctor about, particularly your neurologist if that is an ongoing issue for you.
• Next is DBS, or deep brain stimulation. Deep brain stimulation literally takes electrodes, electrical impulses and targets them to the areas of the brain that produce dopamine deep in the mid-brain. Deep brain stimulation directly impacts the ability to contract the muscles and to move the way you want to move. So most often, or quite often with DBS, folks that have had dystonia and other issues like that, it can be resolved with adjustment of the DBS.
  
• Next on the list is corrective surgery. I don't always like to recommend surgery as a physical therapist. However, there are most definitely cases where surgery is necessary, particularly when it comes to needing something like a total joint replacement, or in the case of pathologic fractures, such as those that occur due to osteoporosis or other causes, there are certain repairs that may need to be done; for example, spinal kyphoplasty or vertebroplasty to repair a fracture of a vertebra. Joint replacement, as I mentioned, and arthroscopic surgeries are also common surgeries that can occur due to age related problems, such as osteoarthritis, and these impairments may have already been there without Parkinson's, but Parkinson's disease certainly could make them more pronounced.
  
• Complimentary and alternative remedies could be sought out as an additional option. For example, especially when it comes to involuntary muscle contractions. When trying to relax things, looking into things like CBD oil or other forms of cannabis may be helpful. That's just one example of a complimentary or alternative remedy, but there are others. Acupuncture, acupressure, and chiropractic are other examples. Those are always options, especially when pain is a chronic issue for you as a person with Parkinson's disease.

In summary, just know that there are remedies out there, and sometimes it takes multiple avenues to get relief from pain. Lastly, and one thing that is not on this list that I gave you but is extremely important, is physical activity and physical exercise. Especially exercise that's targeted to Parkinson's disease, because it can directly result in improvements in some of the negative changes that can happen in the body, such as rigidity of the trunk and muscle tightness, joint tightness, and the like. Exercise also stimulates the brain to produce more dopamine that is an addition to the medications you're taking for Parkinson's disease.

I would highly recommend you check out Parkinson.org. That's the Parkinson's Foundation website. The American Parkinson's Disease Association is also a great resource.