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  • Review Article
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Pains in Parkinson disease—many syndromes under one umbrella

Nature Reviews Neurology volume 8, pages 284–294 (2012)Cite this article

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Abstract

Pain is a nonmotor symptom that substantially affects the quality of life of at least one-third of patients with Parkinson disease (PD). Interestingly, patients with PD frequently report different types of pain, and a successful approach to distinguish between these pains is required so that effective treatment strategies can be established. Differences between these pains are attributable to varying peripheral pain mechanisms, the role of motor symptoms in causing or amplifying pain, and the role of PD pathophysiology in pain processing. In this Review, we propose a four-tier taxonomy to improve classification of pain in PD. This taxonomy assigns nociceptive, neuropathic and miscellaneous pains to distinct categories, as well as further characterization into subcategories. Currently, treatment of pain in PD is based on empirical data only, owing to a lack of controlled studies. The facultative symptom of 'dopaminergically maintained pain' refers to pain that benefits from antiparkinson medication. Here, we also present additional pharmacological and nonpharmacological treatment approaches, which can be targeted to a specific pain following classification using our taxonomy.

Key Points

  • Up to 80% of patients with Parkinson disease (PD) experience chronic pain

  • The basal ganglia are involved in pain processing, but their exact contribution to pain in PD is unclear

  • In a four-tier taxonomy on pains in PD, nociceptive pain must be distinguished from neuropathic and miscellaneous pain

  • 'Dopaminergically maintained pain' refers to pain that can be alleviated by antiparkinson medication

  • Symptomatic analgesic treatment based on clinical pain classification includes pharmacological, nonpharmcological and invasive approaches

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Figure 1: Schematic drawing of the pathways between the substantia nigra and pain-processing areas.
Figure 2: Taxonomy of pains in PD.
Figure 3: Examples of non-dystonic and dystonic pains related to motor fluctuations.101
Figure 4: Relative contributions of DIP and DMP to the overall pain in two hypothetical patients with PD.

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Acknowledgements

The authors' research is supported by the National Health and Medical Research Council of Australia (NHMRC), the German Research Council (SFB 855), the EFIC-Grünenthal-Grant (EGG) and the Ministry for Science and Education of Schleswig-Holstein.

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  1. Klinik für Neurologie, Christian-Albrechts-Universität Kielm, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, Haus 41, 24105, Kiel, Germany

    Gunnar Wasner & Günther Deuschl

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Correspondence to Gunnar Wasner.

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Competing interests

G. Wasner is on the Speakers Bureau for Astellas, Grünenthal, Medtronic, Mundipharma and Pfizer. He is a consultant for Astellas and Amgen and has received research support from Grünenthal. G. Deuschl has received lecture fees from Orion, Lundbeck, Pfizer and Teva and is serving as a consultant for Teva. He has received royalties from Thieme publishers. He is a government employee and receives grant support from the German Research Council, the German Ministry of Education and Health and Medtronic.

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Wasner, G., Deuschl, G. Pains in Parkinson disease—many syndromes under one umbrella. Nat Rev Neurol 8, 284–294 (2012). https://doi.org/10.1038/nrneurol.2012.54

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