title: [Lumbar back pain in patients with Parkinson's disease].
abstract: BACKGROUND
  Lumbar back pain is a frequent symptom in patients with advanced Parkinson's disease. We examined the effect of modification of the dopaminergic medication, x-ray-controlled lumbar spine injections and analgesics combined with physiotherapy.
  
  
  METHODS
  The data from 50 patients with Parkinson's disease and lumbar back pain were retrospectively analyzed. A structured L-dopa test was performed with all patients, whereby the pain intensity and mobility were monitored before and after the administration of L-dopa. Dopaminergic medication was adjusted in patients who reported either a reduction in pain intensity (> 20%) and/or an improvement of measured mobility and X-ray controlled lumbar spine injections were conducted in patients who reported persistent pain. Analgesics were introduced or dosages were raised in patients who had already received lumbar spine injections and continued to report pain. All patients participated in a daily physiotherapy program.
  
  
  RESULTS
  In the L-dopa test an improvement of mobility could be demonstrated in 40 patients and reduced pain intensity in 21 patients. In 37 patients with a positive L-dopa test the dopaminergic medication was adjusted. In 12 of these patients (24%) a decrease of pain intensity could be observed. Due to persisting back pain in 30 patients lumbar spine injections were conducted. Of these patients 17 (34%) had pain improvement. In 20 patients analgesics were applied and induced pain relief in 15 patients (30%). Overall 44 patients (88%) had an improvement in pain.
  
  
  CONCLUSIONS
  Even in cases of severe lumbar spine pathology adjustment of dopaminergic medication should be tested in all patients with Parkinson's disease and lumbar back pain. In patients with persistent pain facet joint injections as well as analgesics may be helpful and should be tested according to the predominant pain characteristics.
authors: Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland. o.rommel@rommel-klinik.de.
authors: O
authors: O
authors: Rommel
authors: Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland.
authors: D
authors: D
authors: Wejwer
authors: Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland.
authors: K
authors: K
authors: Schybek
authors: Abteilung für Orthopädie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland.
authors: T
authors: T
authors: Przybilski
authors: Abteilung für Orthopädie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland.
authors: G
authors: G
authors: Jäger
authors: Abteilung für Neurodegenerative Erkrankungen, Hertie-Institut für Hirnforschung, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.
authors: S
authors: S
authors: Gräber
authors: Abteilung für Neurodegenerative Erkrankungen, Hertie-Institut für Hirnforschung, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.
authors: D
authors: D
authors: Berg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D000978:Antiparkinson Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D015259:Dopamine Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007980:Levodopa; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000978:Antiparkinson Agents; D015259:Dopamine Agents; D007980:Levodopa
keywords: Analgesics; Facet joint; L-dopa; Lumbar back pain; Spinal injections