title: Effects of deep brain stimulation on pain and other nonmotor symptoms in Parkinson disease.
abstract: OBJECTIVE
  To prospectively evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the different characteristics of pain and other nonmotor symptoms (NMS) in patients with Parkinson disease (PD).
  
  
  METHODS
  Forty-four patients with PD and refractory motor symptoms were screened for STN-DBS. Patients were evaluated before and 1 year after surgery. The primary outcome was change in pain prevalence after surgery. Secondary outcome measures were changes in motor function (Unified Parkinson's Disease Rating Scale), characteristics of pain and other NMS using specific scales and questionnaires, and quality of life.
  
  
  RESULTS
  Forty-one patients completed the study. The prevalence of pain changed from 70% to 21% after surgery (p < 0.001). There were also significant improvements in pain intensity, NMS, and quality of life after STN-DBS (p < 0.05). Dystonic and musculoskeletal pain responded well to DBS, while central pain and neuropathic pain were not influenced by surgery. There was a strong correlation between the change in pain intensity and the improvement in quality of life (r = 0.708, p < 0.005). No correlation was found between pain improvement and preoperative response to levodopa or motor improvement during stimulation (r = 0.247, p = 0.197 and r = 0.249, p = 0.193, respectively) or with changes in other NMS.
  
  
  CONCLUSIONS
  STN-DBS decreased pain after surgery, but had different effects in different types of PD-related pain. Motor and nonmotor symptom improvements after STN-DBS did not correlate with pain relief.
  
  
  METHODS
  This study provides Class IV evidence that in patients with idiopathic PD with refractory motor fluctuations, STN-DBS decreases the prevalence of pain and improves quality of life.
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Rubens G
authors.initials: RG
authors.lastname: Cury
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Galhardoni
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Erich T
authors.initials: ET
authors.lastname: Fonoff
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Dos Santos Ghilardi
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Fonoff
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Debora
authors.initials: D
authors.lastname: Arnaut
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Myczkowski
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Marcolin
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Bor-Seng-Shu
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Egberto R
authors.initials: ER
authors.lastname: Barbosa
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil.
authors.forename: Manoel J
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: From the Pain Center, Department of Neurology, School of Medicine (R.G.C., R.G., E.T.F., M.J.T., D.C.d.A.), Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute (E.T.F., D.A., M.L.M., M.A.M., M.J.T.), Movement Disorders Center, Department of Neurology, School of Medicine (R.G.C., E.R.B., M.J.T.), and Neurosurgery Division, Department of Neurology, School of Medicine (E.T.F., M.G.d.S.G., F.F., E.B.-S.-S., M.J.T.), University of São Paulo; and Pain Center (R.G.C., M.J.T.), Instituto do Câncer do Estado de São Paulo, Brazil. ciampi@usp.br.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ciampi de Andrade
mesh_terms: D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010146:Pain / Q000453:epidemiology / Q000503:physiopathology*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010300:Parkinson Disease / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D016896:Treatment Outcome