title: Do dyskinesia and pain share common pathophysiological mechanisms in Parkinson's disease?
abstract: Plastic changes within the striatum resulting from pulsatile dopaminergic stimulation are thought to lead to dyskinesia in patients with Parkinson's disease (PD). The basal ganglia play a role in processing pain. We hypothesized that the plastic changes that lead to dyskinesia may also mediate pain responses. Our objective was to compare the change in pain sensitivity after levodopa administration between stable responders, fluctuators without dyskinesia, and dyskinetic patients, and to compare pain sensitivity between PD and healthy subjects. Fifty patients with PD were assessed with cold water immersion after overnight withdrawal of dopaminergic medications and again after a standard levodopa challenge, and carefully classified into stable responder (n = 12), fluctuator (n = 15), and dyskinetic (n = 23) groups. Twenty age-matched controls were also tested. PD patients "off"-medication had a lower threshold (P = 0.016) and tolerance (P < 0.0001) to cold pain compared to controls. After levodopa administration, dyskinetic patients experienced a large increase in cold pain threshold (48%) and tolerance (66%) that was absent in stable responders (P = 0.038 and P = 0.015); there was no significant difference in pain sensitivity change scores between the fluctuator and either the stable responder or dyskinetic groups. Our results suggest that dyskinesia and pain may share common pathophysiological mechanisms in PD.
authors: Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors: Shen-Yang
authors: SY
authors: Lim
authors: Michael J
authors: MJ
authors: Farrell
authors: Stephen J
authors: SJ
authors: Gibson
authors: Robert D
authors: RD
authors: Helme
authors: Anthony E
authors: AE
authors: Lang
authors: Andrew H
authors: AH
authors: Evans
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D020820:Dyskinesias / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects / Q000502:physiology*; D020734:Parkinsonian Disorders / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa