“Don’t give in to Parkinson’s—you may not win the war, but you will win quite a few battles.”
—BRIAN S., PWP
Pain is quite common for people with Parkinson’s; it is said that up to 75 percent of those affected experience some type of disease-related pain.34 In some cases, symptoms such as stiffness and tremors may make it difficult to recognize the effect of pain on the condition. In others, pain may be the primary symptom. Because of this, it is crucial that people with Parkinson’s and their caregivers be aware of the different types of pain that may present and the problems they may cause.
Musculoskeletal pain is the most common type of pain in PD. It is often caused by muscle rigidity, which leads to cramps and spasms. Often point-specific and centered in the muscles and bones, musculoskeletal pain is typically felt as an ache around the joints, arms, and legs. This type of pain does not move around or shoot down limbs. It may respond to a combination of painkillers (such as acetaminophen) and regular exercise and/or physical therapy.
Radicular pain is sharp and shooting. It is often the result of a nerve being trapped inside the spinal cord by protruding discs, arthritis, or another spinal injury. This type of pain can feel like a shock that travels down an arm or leg. It may be associated with tingling, numbness, or a burning sensation in the fingers and toes.
If you experience radicular pain, you should talk to your doctor. You may need an x-ray or neurological testing to rule out injury to the area or spinal cord. In most cases, over-the-counter medications and regular light exercise will be treatment enough.
Akathisia is a sense of restlessness that can cause aching and discomfort. Often occurring at night, it may make it difficult to sleep, sit still, drive a car, or sit at a table. Akathisia commonly involves the legs.
If you experience akathisia, you may find yourself wandering around or fidgeting in an effort to find some relief. These symptoms often fluctuate with medication usage. Consult with your doctor to find out if a change in medication schedule may be helpful in reducing your symptoms.
Most people with Parkinson’s experience constipation at some point, and this often occurs before they are diagnosed. Abdominal pain may range from minor to major, especially if there is severe bloating. You may want to consult with a gastroenterologist if abdominal pain is an issue for you.
Dyskinesia is difficulty or distortion in performing voluntary movements, resulting in abnormal and involuntary actions. It is often described as a rolling or writhing motion, though it may also cause an aching pain. Dyskinesia may occur in response to high dopamine levels and may be most severe when levodopa is at its peak concentration in the blood. Higher doses of levodopa may cause increased dyskinetic pain.
If you are experiencing dyskinesia, your doctor may need to reduce your individual levodopa dosage, add dopamine agonists, or prescribe an apomorphine skin injection. Some studies also suggest that the drug amantadine may be useful for the short-term management of levodopa-induced dyskinesia. My mom took this drug, but she had to work with her doctor to get the dosages just right because too much of it in her system caused her to hallucinate.
As dyskinesia can get worse with stress, it’s important to take care of yourself. Hobbies such as gardening (this was Mom’s favorite), yoga, tai chi, and other forms of exercise may be helpful. One simple way my mom found to stop her dyskinesia was to go for a brisk walk. She said that doing any kind of purposeful activity helped.
Dystonia is the involuntary contraction of muscles, causing uncontrollable repetitive or twisting movements of the affected body part. Dystonia can be very painful, if not debilitating, depending on the body part affected. A common form involves the feet and toes, which may curl painfully and make it difficult to walk.
Dystonic pain may be alleviated by long-acting levodopa dosing (Madopar HBS or Sinemet CR) or a dopamine agonist. In severe cases, the doctor may prescribe Botox injections to reduce muscle contractions.
The following types of pain are less common in PD.
• Burning mouth
• Shoulder, arm, and leg pain and stiffness
• Coat hanger pain
• Akinetic crisis pain
• Headache
• Muscle cramps
If you have any kind of pain, you need to let your primary care doctor and your neurologist know right away. Most common types of pain are easily managed, but others may require a combination of medications, specialty care (e.g., massage therapy, physical therapy, acupuncture), exercise, and Botox injections. Your doctor will determine which treatment is best for you.