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Pain in Parkinson's Disease

Updated: May 11, 2023

Information on what causes pain, sources of pain, and techniques to manage your pain.


This post serves as a supplement on how to use non-pharmacological approaches for managing it. It provides a comprehensive overview of the topics discussed during the presentation and serves as a reference guide for individuals looking to understand and manage their pain.


Disclaimer: This document is for general informational purposes only and is not intended to be a substitute for professional advice, diagnosis, or treatment.


Introduction:

  • Pain is a common and often under-recognized symptom of Parkinson's disease (PD), affecting up to 80% of people with the condition.

  • To effectively manage pain and improve quality of life, it is important to understand pain science and develop a range of skills to cope with pain without relying heavily on medication.

  • "P.D. PowerUp: Parkinson's Disease Pain Management Program" is a comprehensive virtual group program designed to empower individuals with PD to actively self-manage their pain using non-pharmacological approaches.

Understanding Pain in PD:

Pain is a multidimensional experience that encompasses the bio-psycho-social aspects of pain. The bio aspect of pain is often associated with the relationship between disease and bodily health, including tissue pathology, nociception, inflammation, and systemic changes. The psycho aspect of pain relates to the mental and emotional wellness of the individual, including motivations and stress. The social aspect of pain is associated with interpersonal factors such as social interactions, community factors, as well as lifestyle, and social support.


To better understand the pain in PD, it's important to classify it into different domains. These domains include musculoskeletal pain, dystonia-associated pain, radicular or peripheral pain, primary central pain, and akathitic discomfort. By understanding these different domains, individuals can better identify their specific type of pain and create a treatment plan that addresses their unique needs.


Nociceptive Pain

(Musculoskeletal pain & Dystonia-associated pain due to motor fluctuations)

Pain that is related to the bones, muscles, and joints, can include chronic pain conditions such as osteoarthritis or fibromyalgia. In PD, it can be caused by muscle stiffness, bradykinesia, and postural abnormalities.


Dystonia is a type of muscle disorder that causes abnormal postures, twisting and repetitive movements, and muscle contractions. Pain associated with dystonia can be classified into two types: off-related and nocturnal. Off-related dystonia is pain that occurs when the medication wears off, and nocturnal dystonia is pain that occurs during the night.


Neuropathic Pain (Radicular or peripheral pain)

This type of pain is caused by inflammation or compression of the nerves that travel from the spinal cord to the rest of the body. Neuropathic features of pain include burning, electric shock-like, pins, and needles sensations. It is caused or exacerbated by the postural changes in PD.


Nociplastic Pain (Primary Central pain):

This type of pain is caused by changes in the central nervous system, such as PD-related changes in the brain or spinal cord. Central pain is commonly presented as an unexplainable, stabbing, a burning sensation often diffused across the body.


Akathisia is a type of motor disorder characterized by inner restlessness and a feeling of "crawling skin." In some cases, akathisia can cause discomfort and pain, leading to increased agitation, anxiety, and depression.


It's important to note that the pain experienced by individuals with PD can be complex and may involve several types of pain, it can also be difficult to diagnose. A proper evaluation and assessment are important to differentiate PD-related pain from other types of pain and to develop an appropriate treatment plan.


Causes of Pain in PD:

To effectively manage pain in Parkinson's disease, it is important to understand the underlying causes.

There are several factors that can contribute to pain in PD, including:

Muscle rigidity: This refers to stiffness and tension in the muscles, which can lead to pain and discomfort.


Dystonia: This is a movement disorder characterized by sustained muscle contractions and abnormal postures, which can cause pain and discomfort.


Bradykinesia (slowness of movement): This refers to difficulty in initiating and performing movements, which can lead to pain and discomfort in the muscles and joints.


Systemic changes: Parkinson's disease can cause changes in the body's immune and nervous systems which can lead to increased inflammation and pain.


Stress: Stress and anxiety can exacerbate pain in Parkinson's disease by increasing muscle tension and inflammation.


It's also important to consider that pain in PD can also occur due to non-PD-related causes, such as musculoskeletal pain from degenerative arthritis, for example. Therefore, it's essential to consult with a healthcare provider to rule out other potential causes of pain, and to develop a comprehensive pain management plan that addresses all potential sources of pain.


Assessing and Tracking Pain:

Self-report measures: These include questionnaires and diaries that help individuals rate their pain intensity, frequency, and location, as well as its impact on their daily life. These measures are easy to use and can provide valuable information on the individual's pain experience.


Observational scales: These include assessments that rely on an observer or healthcare professional to rate pain based on observation of the individual. These may include ratings of facial expressions, body language, or muscle tone.


Physiological measures: These include measuring changes in heart rate, blood pressure, or skin conductance in response to pain. These measures can provide objective information on pain experience but may be less practical in clinical settings.


Treatment using Non-pharmacological Approaches:

The good news is that scientific studies over many years have shown that pain management using non-pharmacological approaches can address many of these changes. Pain management helps individuals to adapt back to “normal” and will slowly help reduce pain, distress, and disability. Pain management will help individuals to:

  • Move differently

  • Become fitter and more flexible

  • Breathe differently

  • Think differently (understand their pain system and not fear pain)

  • Behave differently (respond differently)

Exercise is an important non-pharmacological approach to managing pain in PD. The power of neuroplasticity, the brain's ability to reorganize itself by forming new neural connections, can be harnessed through exercises to manage pain.


When integrating exercises for pain management in PD, it is important to consider the following key considerations:

  • Safety: Ensure that the exercises are safe and suitable for the individual's condition and fitness level.

  • Progression: Gradually increases the intensity and complexity of the exercises as the individual's fitness level improves.

  • Customization: Tailor the exercises to the individual's needs and preferences.

  • Consistency: Maintain consistency in the exercise program to achieve the best results.

A multimodal pain management approach is important for managing pain in PD. It combines different treatment modalities such as pharmacological, non-pharmacological, and psychological interventions to provide comprehensive pain


Physical therapy: Physical therapy interventions can help individuals with PD improve their muscle strength, flexibility, and coordination, which can be particularly beneficial in managing pain caused by muscle rigidity or dystonia.


Exercise: Exercise has been shown to be beneficial for individuals with PD in managing pain. Exercise can improve muscle strength and flexibility, which can help manage pain caused by muscle rigidity or dystonia, as well as improve overall cardiovascular fitness.


Occupational therapy: Occupational therapy interventions can help individuals with PD develop strategies for coping with pain and maintaining independence in their daily activities. Occupational therapists can also provide adaptive equipment or modifications that can help individuals with PD manage pain and improve overall functionality.


Psychological therapies: Techniques such as cognitive behavioral therapy and pain management education can help individuals better understand their pain, develop coping strategies, and improve their emotional well-being.


Relaxation techniques: Relaxation techniques such as deep breathing, yoga, and meditation can help reduce muscle tension and decrease pain.


Overall, non-pharmacological approaches for managing pain in PD have been shown to be effective and can improve muscle strength, flexibility, and coordination, improve mood, reduce stress, and promote overall well-being.


Self-Management of Pain in PD: The P.D. PowerUp Program


Self-management programs are now commonplace in healthcare and have been proven to help individuals improve their quality of life. The goal of these programs is to help individuals become experts in managing their pain, alleviate fears or concerns they have about pain provoked by activity, become fitter and healthier despite their pain, and provide them with a “toolbox” of skills, techniques, and exercises that will help them stay active and return to previous activities.


BeyondRehab is proud to offer the "P.D. PowerUp: Parkinson's Disease Pain Management Program" which is a comprehensive virtual group program designed to empower individuals with PD, particularly those between the ages of 50-65+ with mild to moderate severity of the condition, to actively self-manage their pain using non-pharmacological approaches. The program consists of 8 virtual sessions delivered over 4 weeks in a small group setting of 6-8 people.

  • Week 1 focuses on understanding pain neuroscience and ways to deconstruct the pain experience and optimize neuroplasticity through grounding practices.

  • Week 2 focuses on re-connecting and re-training the mind-body connection through sensory training and the identification of appropriate exercise types and dosages for PD.

  • Week 3 addresses flare-up pain and freezing episode management, helping participants understand potential causes and triggers and develop effective strategies to manage them.

  • Week 4 participants learn how to advance their skill sets, engage in task-specific strengthening, and integrate into the community to facilitate a return to higher levels of function.

An initial evaluation is conducted to assess baseline condition, followed by biweekly progress reviews to track the functional status, and monitor progress.


Participants in the P.D. PowerUp have found it to be helpful and have reported decreased dependency on over-the-counter pain medications by 20%, increased use of active coping strategies by 35%, and improved confidence and engagement in physical activities.


Let's Connect

If you're interested in learning more about the P.D. PowerUp: Parkinson's Disease Pain Management Program and how it can help you manage your pain and improve your quality of life, please visit www.beyondrehab.health to schedule a free discovery call. You can also reach out to us at info@beyondrehab.health or by phone at 206-414-8610 to schedule a consultation and discuss how the program can benefit you. We look forward to hearing from you and helping you take control of your pain management journey.


Additionally, get your Parkinson's Wellness Report to learn about your Parkinson's presentation and receive personalized recommendations from the neuro expert!

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