Painful sensory symptoms in neuroleptic-induced extrapyramidal syndromes.
OBJECTIVE
The authors tested the hypothesis that neuroleptic-induced extrapyramidal syndromes are associated with painful sensations objectively conforming to the characteristics of primary sensory symptoms as reported in idiopathic and postencephalitic parkinsonism.


METHODS
The frequency of subjective painful sensory symptoms and their relation to neuroleptic-induced extrapyramidal syndromes were examined in a consecutive series of 107 psychiatric patients newly admitted to acute care units at a teaching hospital. Patients without illnesses or conditions likely to be associated with pain were included in the study if they had a diagnosis other than organic mental syndromes and were receiving psychotropic medications as prescribed by their treating physicians. Structured interviews with a modified version of the McGill Pain Questionnaire to assess sensory complaints and neurological examinations for neuroleptic-induced extrapyramidal syndromes (parkinsonism and akathisia) were conducted independently by two raters blind to each other's findings and patients' medication status.


RESULTS
Fourteen (23%) of 60 patients receiving neuroleptics reported experiences of spontaneous pain subjectively attributed to pharmacological treatment, compared with only one (2%) of 47 patients receiving psychotropic medications other than neuroleptics. There was no difference between these two groups in subjective complaints of paresthesia (8% versus 9%). Twelve (55%) of the 22 patients with neuroleptic-induced extrapyramidal syndromes reported pain, compared with only two (5%) of the 38 patients who received neuroleptics but did not experience extrapyramidal syndromes.


CONCLUSIONS
Although consonant with the study hypothesis, these results should be regarded as preliminary and interpreted conservatively in the light of the methodological limitations of the study.
Department of Psychiatry, New York Hospital-Cornell Medical Center, New York City.
P
P
Decina
S
S
Mukherjee
G
G
Caracci
K
K
Harrison
D000328:Adult; D017109:Akathisia, Drug-Induced; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000175:diagnosis; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000139:chemically induced* / Q000175:diagnosis; D010147:Pain Measurement; D010292:Paresthesia / Q000139:chemically induced / Q000175:diagnosis; D010302:Parkinson Disease, Secondary / Q000139:chemically induced / Q000175:diagnosis; D010554:Personality Disorders / Q000188:drug therapy; D011595:Psychomotor Agitation / Q000175:diagnosis; D011619:Psychotropic Drugs / Q000009:adverse effects; D012559:Schizophrenia / Q000188:drug therapy
D014150:Antipsychotic Agents; D011619:Psychotropic Drugs