Pain Treatment for Patients With Parkinson an Unmet Need

Pain treatment for patients with Parkinson disease (PD) remains an unmet need, wrote researchers recently, recommending strategies for providers to think about when managing this population.

Pain is considered a non-motor symptom (NMS) that may hinder daily activities and health-related quality of life (HRQoL), they said. However, only about half of patients with pain use analgesics, and pain is often managed by simply increasing doses of PD medications.

Evaluations for pain should go beyond the usual emphasis of quality and severity of pain and also include the disabling effects and impact on psychological well-being, including mood, depression, and anxiety. The authors noted 2 screening tools which may be helpful for providers working with patients with PD. The King’s PD Pain Scale (KPPS) represents the first pain tool designed for patients with PD and is aimed at assessing the presence of pain seen in these situations. In addition, there is a proposed a patient-completed tool to go along with the KPPS: The King’s College PD Pain Questionnaire (KPPQ) is a 14-item questionnaire composed of “yes” or “no” questions designed to assess whether a specific kind of pain is present.

The most common type of pain reported in PD is musculoskeletal pain, affecting 10.6% to nearly 70% of patients. It is the result of Parkinsonian rigidity, immobility, and postural abnormalities. Moreover, the motor impairment may exacerbate joint pain from arthritis or other disorders. Among musculoskeletal painful conditions, shoulder pain of variable severity has been reported and is an under-recognized pre-motor PD symptom, which exposes the patient to ineffective surgical procedures. It should be an important warning for the disease, the authors wrote.

Given the complex nature of pain, multimodal approaches, including both drug and nondrug treatments, should be used, the authors advised; in addition, a multidisciplinary approach involving different medical specialists should be involved in care.

Additional research is needed, the authors said, such as on the use of opioids in moderate to severe pain, the interference of pain medications on PD drugs, the use of agents against neuropathic pain, and the different subgroups of patients with PD.

Reference

Cuomo A, Crispo A, Truini A, et al. Toward more focused multimodal and multidisciplinary approaches for pain management in Parkinson’s disease [published online July 22, 2019]. J Pain Res. doi: 10.2147/JPR.S209616.