Pain in Extrapyramidal Neurodegenerative Diseases.
Pain is one of the most common nonmotor symptoms of Parkinson disease (PD) and other Parkinson plus syndromes, with a major effect on quality of life. The aims of the study were to examine the prevalence and characteristics of pain in PD and other Parkinson plus syndromes and patient use and response to pain medications.



The cohort consisted of 371 patients: 300 (81%) with PD and 71 (19%) with Parkinson plus syndromes. Data on clinical parameters and pain were collected by questionnaire. Disease severity was measured with the Unified PD Rating Scale for patients with PD.



Pain was reported by 277 patients (74%): 241 with PD and 36 with Parkinson plus syndromes. The prevalence of pain was significantly higher in the patients with PD than in the patients with Parkinson plus syndromes (80% vs. 50%, P<0.001) and higher in patients with synucleinopathies than in patients with tauopathies (70% vs. 40%, P<0.001). In the synucleinopathies, the most common pain was central pain (32%), whereas in the tauopathies only 4% of patients had central pain. Anti-Parkinson treatment relieved the pain in 21% of the patients with PD. Only 114 patients (48%) who experienced pain were treated with pain medications. The most beneficial analgesics were nonsteroidal anti-inflammatory drugs and medical cannabis.



Pain is prevalent among patients with PD and Parkinsonian plus syndromes. Pain relief can be achieved by more intensive anti-Parkinson medications or pain medications.
*Department of Neurology, Movement Disorder Clinic, Rabin Medical Center, Beilinson Hospital, Petach Tikva ‡Movement Disorders Unit, Tel Aviv Sourasky Medical Center †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Shlomit
S
Yust-Katz
Ronly
R
Hershkovitz
Tanya
T
Gurevich
Ruth
R
Djaldetti
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D015331:Cohort Studies; D005116:Extrapyramidal Tracts / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications*; D010146:Pain / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement; D010300:Parkinson Disease / Q000150:complications*; D012720:Severity of Illness Index; D013494:Supranuclear Palsy, Progressive / Q000150:complications*; D011795:Surveys and Questionnaires
D000893:Anti-Inflammatory Agents; D000697:Central Nervous System Stimulants