Pain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy
- 731 Downloads
We aimed to evaluate prevalence, phenotype, and therapeutic realities of pain in patients with Parkinson disease (PD). Therefore, we assessed 181 outpatients with PD using a cross-sectional approach applying the German Pain Questionaire (DSF), the PainDetect, and a self-developed Parkinson Disease Pain Questionaire (UPDPQ) covering detailed therapeutic aspects. Furthermore, we investigated the association between pain and PD-disease characteristics, quality of life (PDQ-39), depression, and anxiety (HADS-D, HADS-A). Overall, prevalence of pain was high (95.4%); 91.1% suffered from chronic pain, but in only 22.3% of them, pain disorder was diagnosed. Pain impaired everyday-life moderately to very severely in 48.4% of patients and was the most distressing symptom in 10.2% of all patients. Pain was localized mainly in the back (71.4%) or joints (52.4%), frequently occurred as pain attacks (79%) but appeared with neuropathic character in only 15.3% of patients. Most patients (74.2%) received some kind of pain treatment, mainly provided by orthopedists (62.0%) or general practitioners (50.0%). Physiotherapy (61.3%), pain killers (54.4%), or massage (35.5%) were the most frequent therapeutic measures. Rehabilitative therapy (96.3%) and physiotherapy (89.5%) were rated as most effective, but with vastly temporary effects. 53.3% of patients attributed PD as the main cause for their pain, but only 33.6% found relief from anti-parkinsonian drugs. High levels of pain were associated with higher scores of depression and anxiety, and lower quality of life. Results suggest that pain in PD is frequent, complex, and quality-of-life-impairing but under-diagnosed and unsystematically treated and indicate need to systematically investigate pathophysiology-based treatment strategies.
KeywordsParkinson disease Pain Prevalence Therapy Quality of life
Compliance with ethical standards
Financial disclosure/conflict of interest concerning the research related to the manuscript
This work was supported by grants from the German Research Foundation (SFB936/1[UB]), the German Parkinson Foundation (Deutsche Parkinson Vereinigung (dpv) e.V. [WG, CB, UB]), and the LIIRA Grant by Pfizer (UB). The funders played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflicts of interest
C Buhmann has received grants from the German Parkinson foundation (=Deutsche Parkinsonvereinigung dPV e.V.) and the Georg & Jürgen Rickertsen Stiftung Hamburg; he has received honoraria as speaker and scientific advisory board member from UCB and Zambon during the conduct of the study. Ulrike Bingel received grants from the dPV, BMBF (FK01GQ0808), Pfizer (LIIRA), German Research Foundation (SFB936), and received honoraria as a speaker from Grünenthal, Teva, Bionorica, Ipsen, Boehringer Ingelheim, and Allergan during the conduct of the study. Wiebke Grashorn received a grant from the dPV during the conduct of the study. N. Wrobel, O. Fruendt, K. Wesemann, and S. Dietrich have nothing to disclose.
- 10.Chaudhuri KR, Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, Brown RG, Koller W, Barone P, Macphee G, Kelly L, Rabey M, MacMahon D, Thomas S, Ondo W, Rye D, Forbes A, Tluk S, Dhawan V, Bowron A, Williams AJ, Olanow CW (2006) International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson’s disease: the NMSQuest study. Mov Disord 21:916–923CrossRefPubMedGoogle Scholar
- 11.Chaudhuri KR, Rizos A, Trenkwalder C, Rascol O, Pal S, Martino D, Carroll C, Paviour D, Falup-Pecurariu C, Kessel B, Silverdale M, Todorova A, Sauerbier A, Odin P, Antonini A, Martinez-Martin P (2015) King’s Parkinson’s disease pain scale, the first scale for pain in PD: an international validation. Mov Disord 30:1623–1631CrossRefPubMedGoogle Scholar
- 20.Herrmann C, Buss U, Snaith RP (1995) HADS-D: Hospital Anxiety and Depression Scale-Deutsche Version; ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Verlag Hans Huber, Bern, SchweizGoogle Scholar
- 26.Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, Macphee G, Brown RG, Naidu Y, Clayton L, Abe K, Tsuboi Y, MacMahon D, Barone P, Rabey M, Bonuccelli U, Forbes A, Breen K, Tluk S, Olanow CW, Thomas S, Rye D, Hand A, Williams AJ, Ondo W, Chaudhuri KR (2007) Prevalence of nonmotor symptoms in Parkinson’s disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Mov Disord 22:1623–1629CrossRefPubMedGoogle Scholar
- 33.Riedel O, Klotsche J, Spottke A, Deuschl G, Forstl H, Henn F, Heuser I, Oertel W, Reichmann H, Riederer P, Trenkwalder C, Dodel R, Wittchen HU (2010) Frequency of dementia, depression, and other neuropsychiatric symptoms in 1,449 outpatients with Parkinson’s disease. J Neurol 257:1073–1082CrossRefPubMedGoogle Scholar
- 38.van Nimwegen M, Speelman AD, Smulders K, Overeem S, Borm GF, Backx FJ, Bloem BR, Munneke M (2010) Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients. BMC Neurol 10:70CrossRefPubMedPubMedCentralGoogle Scholar