Pain and Parkinson’s

Descriptions of Parkinson’s do not generally include the mention of pain. Yet, when carefully questioned, more than half of all people with Parkinson’s say that they have experienced painful symptoms such as aching, stiffness, numbness and tingling at some point in the course of the illness. For a few of them, pain and discomfort are so severe that they overshadow the other problems caused by the disease. However, the reasons for this are that patients are usually unaware that pain could be associated with Parkinson’s.

A PwP could be suffering from various types of pain such as

  • Musculoskeletal pain which involves aching muscles, joints and body parts. Rigidity, lack of spontaneous movement, abnormalities of posture, gait and awkward mechanical stresses all contribute to musculoskeletal pain in PD. One of the most common musculoskeletal complaints is shoulder stiffness, sometimes called a frozen shoulder.
  • Central pain syndrome which is presumed to be a direct consequence of the disease itself is described by patients as bizarre unexplained sensations of stabbing, burning and scalding, often in unusual body distributions: the abdomen, chest, rectum, genitalia, or mouth.
  • Dystonic spasms (painful cramps) are among the most painful symptoms that a person with PD may experience. Dystonia in Parkinson’s may affect the limbs, trunk, neck, face, tongue, jaw, swallowing muscles and vocal cords, and most commonly affects the feet and toes which may curl painfully. The most important step in evaluating dystonia is to establish its relationship to dopaminergic medication. Does the dystonia occur when the medication is at peak effect or its effects are waning? This will usually clarify the nature of the dystonia, and determine its treatment. Most painful dystonia represents an “off” Parkinson’s phenomenon, and occurs early in the morning or during wearing-off spells.

What causes Pain in Parkinson’s?

  • The ‘on – off mechanism’ which is basically related to the effects of the medicine. Therefore, the underlying mechanism here is the level of dopamine, the brain chemical associated with Parkinson’s.
  • Another reason of pain can be due to the cardinal symptoms of Parkinson’s such as tremors, rigidity and bradykinesia.
  • Difficulty with sleeping and sleep disorders can cause pain too.
  • However, the most common cause of pain is ‘Psychological Symptoms’. Depression, anxiety, panic, stress can all be an initial cause of pain, as well as, increase the potency of pain one is already experiencing. Various studies have found that ALL kinds of pain have a psychological component attached to it. Therefore, it is this “hidden” source of pain that is considered the most important in the management of pain.
Coping with Pain in Parkinson’s
For most PwPs, pain is not the foremost and overpowering problem and therefore it can be managed by the persons themselves with a few general tips. However, a PD patient should not assume that the pain they are experiencing is solely due to the disease. It could be due to an unrelated condition, which left undetected could prove very hazardous.

One can follow simple steps to decrease the feeling of pain.

  • Exercise & Physiotherapy – can help strengthen muscle, provide a general sense of well-being, increase mobility etc. These include general exercises such as walking, jogging, aerobics, swimming, cycling. Exercise helps by releasing endorphins, the body’s natural painkilling substances. Physiotherapy is a more specialized way of dealing with pain through tailor – made exercises & ‘education’ involving the teaching of the right posture, right gait, body mechanics, importance of rest, and methods of energy conservation.
  • Simple Home Remedies – for local treatment of pain, one can use these simple remedies.
    – Hot water compress which increases circulation and thus reduces pain.
    – Cold / ice packs which reduce swelling.
    – Dried Ginger – Water pack.
    – Asafetida – Castor oil pack.
  • Stress management techniques deal with the psychological components of pain, thus providing relief. These include,
    – Relaxation where several methods exist, & the most common known as Progressive Relaxation (by Edmund Jacobson) involves progressively targeting, tensing and relaxing various muscle groups in the body, working ones way upward from toes to head.
    – Guided imagery where thinking of a relaxing environment and taking yourself there – i.e. lying on a tropical beach – may facilitate relaxation.
    – Thought Stopping / Distraction where instead of asking yourself “how was the pain today?” Rather ask yourself – what activities were you involved in? How did you feel?
  • Massage is another technique which decreases spasms and thus relieves pain.

Thus adapting from a William Styron quote, “Pain can’t hurt you unless you let it”