5 Common Sources of Parkinson's Pain and Treatment Options (with Dr. Iris Wingrove)
Guest post by Dr. Iris Wingrove, MD, from Optimize Neurology
Susie Lightfoot-Scherr (former CAPS President) and Dr. Iris Wingrove (Optimize Neurology)
"What a Pain!"
Dr. Iris Wingrove of Optimize Neurology was the featured speaker at the Capital Area Parkinson's Society. She led a fascinating discussion about the most common types of pain syndromes that many people with Parkinson's experience yet never discuss.
Her talk touched on the 5 major sources of pain for someone with Parkinson's as well as the best treatment methods to manage and control one's symptoms. If you have pain and Parkinson's this was a great lecture!
If you missed it, have no fear. Dr. Wingrove agreed to write a recap of her lecture with the "big-hitters".
Take it away, Dr. Wingrove!
Parkinson’s and Pain - 5 Types
Having pain with Parkinson's is not at all uncommon.
It is important to recognize the type of pain you’re having in order to work on its management so it doesn't pose unnecessary barriers in improving your activity level, mood, or sleep quality.
Keep in mind that Parkinson's pain can be present at any stage in the disease, even sometimes before our PD is diagnosed!
Compared to the normal population, pain is felt at a higher rate in Parkinson's. However, compared to the normal population, Parkinson's patients receive less treatment for pain!
Let's go over 5 main types of Parkinson’s pain and some of the treatment options that can help (it doesn't always mean medication!).
1) Musculoskeletal Pain and Parkinson’s
What it feels like:
This is the type of joint and muscle pain that we all probably recognize the most. The arthritis in our joints, that soreness in our muscles.
Parkinson’s can compound this wear and tear from changes in mechanics of your posture and rigidity in your torso or limbs. Sometimes "frozen shoulder" is an initial pain presentation related to Parkinson's that is brought on well before a Parkinson’s diagnosis.
Treatment modalities to consider:
Seeing a physical therapist
Getting a massage
Acupuncture
Improving nutrition and optimizing vitamin D levels
Using anti-inflammatory creams or medication
Tweaking (or starting) Parkinson's medications to decrease rigidity
2.) Neuropathic Pain and Parkinson’s
What it feels like:
Nerve root irritation or "pinched nerves" in our neck or back can cause localized pain at those sites or send shooting electrical sensation down your arms, trunk, abdomen, or legs.
Neuropathic pain can also be due to neuropathy (unhealthy nerves) which have many causes, including diabetes. This pain is typically burning in nature, but can also be a feeling of cold or numbness or pins and needles.
Treatment modalities to consider:
Physical therapy to help with irritated nerve roots from disc bulges or bony spur changes
Improved nutrition, specifically vitamin supplementation
Nerve pain targeting medications or creams/lidocaine patches
Surgical intervention (when appropriate)
3.) Restless Leg Syndrome (RLS) Pain and Parkinson’s
What it feels like:
Restless Leg Syndrome commonly involves the legs but can affect any part of the body. You often feel an urge to move or a feeling of restlessness. It is most pronounced when you are inactive or trying to relax.
RLS can be caused by neuropathies, radiculopathies (pinched nerve roots), genetics, or low iron. Given the timing of this type of pain, it is important to identify as it may be disrupting our ability to fall or stay asleep.
Treatment modalities to consider:
Exercising earlier in the day
Taking a warm bath before bedtime
Massaging with lotion or essential oils
Yoga or stretching
Iron supplementation if ferritin levels are below 70 ng/mL
Nerve pain targeting medications or some Parkinson's medications can also help
4.) Dystonia Pain and Parkinson’s
What it feels like:
This is pain due a Parkinson’s symptom called "dysonia” which are muscle contractions that can cause twisting or abnormal postures. Dystonias can be focal, meaning they impact one area of the body. Examples include “writer's cramp”, neck pulling (torticollis), cramping of your vocal cords, or strong foot cramps.
Sometimes they can be be more extensive involving entire limbs or even be generalized throughout our body.
Treatment modalities to consider:
A good place to start is assess if adjustments need to be made to the Parkinson’s medication dosing you are already on.
Techniques that can elicit the relaxation-response (breathing meditation/mindfulness)
Botox injections in the affected muscles
Anti-cholinergic or muscle relaxants (for some)
Read our Bookmarkable Guide to Dystonia here
5.) Central Pain and Parkinson’s
What it feels like:
Pain is processed and interpreted in our brains. Central pain is a result of your brain mis-interpreting pain sensations in your body and having an abnormal reaction.
It is the type we know least about, but there have been interesting PET and nuclear studies that show areas of our brain affected by Parkinson’s (the basal ganglia and nigrostriatal dopaminergic system) play a role in the modulation of pain.
Many times this type of pain is one of exclusion of other conditions, and so the modalities will usually involve trying many of the aforementioned ones!
However, as a good reminder, always taking care of the basics is a good checklist for any type of pain control:
getting enough restorative sleep,
good nutrient-rich meals,
taking care of your physical, cognitive, and emotional well-being
I hope you have some new topics to talk through with your families and health care team to help find the best strategies to help you feel better soon!
My best,
Dr. Iris Wingrove, MD