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Zhu M, Li M, Ye D, Jiang W, Lei T, Shu K. Sensory symptoms in Parkinson's disease: Clinical features, pathophysiology, and treatment. J Neurosci Res 2016; 94:685-92. [PMID: 26948282 DOI: 10.1002/jnr.23729] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/30/2016] [Accepted: 02/15/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Mingxin Zhu
- Department of Neurosurgery; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Man Li
- Department of Anesthesiology; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Dawei Ye
- Department of Neoplasm; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Wei Jiang
- Department of Neurosurgery; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Ting Lei
- Department of Neurosurgery; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Kai Shu
- Department of Neurosurgery; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
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Mylius V, Pee S, Pape H, Teepker M, Stamelou M, Eggert K, Lefaucheur JP, Oertel W, Möller JC. Experimental pain sensitivity in multiple system atrophy and Parkinson's disease at an early stage. Eur J Pain 2016; 20:1223-8. [DOI: 10.1002/ejp.846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 12/12/2022]
Affiliation(s)
- V. Mylius
- Department of Neurology; Philipps University; Marburg Germany
- Center for Neurorehabilitation; Valens Switzerland
| | - S. Pee
- Department of Neurology; Philipps University; Marburg Germany
| | - H. Pape
- Department of Neurology; Philipps University; Marburg Germany
| | - M. Teepker
- Department of Neurology; Philipps University; Marburg Germany
| | - M. Stamelou
- Department of Neurology; Philipps University; Marburg Germany
- Movement Disorders Clinic; Second Department of Neurology; University of Athens; Greece
| | - K. Eggert
- Department of Neurology; Philipps University; Marburg Germany
| | - J-P. Lefaucheur
- Service de Physiologie - Explorations Fonctionnelles; Hôpital Henri-Mondor; AP-HP; Université Paris-Est; Créteil France
| | - W.H. Oertel
- Department of Neurology; Philipps University; Marburg Germany
| | - J. C. Möller
- Department of Neurology; Philipps University; Marburg Germany
- Parkinson Center; Center for Neurological Rehabilitation; Zihlschlacht Switzerland
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Abstract
BACKGROUND This is a case-control study to investigate the prevalence, characteristics, and risk factors of pain in patients with Parkinson's disease (PD). METHODS A total of 200 PD patients from eastern China were enrolled in our study. Accordingly, 200 healthy elderly adults were recruited as controls. The characteristics of pain were collected by using the Visual Analog Scale, Brief Pain Inventory (BPI), SF-36 Bodily Pain Scale, Unified Parkinson's Disease Rating Scale, Hoehn-Yahr Scale (H-Y), Hamilton Depression Scale, and Leeds Assessment of Neuropathic Symptoms and Signs. RESULTS Of the 200 PD patients, pain was complained by 106 patients (53%). According to the SF-36 Bodily Pain Scale, pain morbidity in PD patients was significantly higher than in the control group. The average pain during last 24 h measured by the BPI was 2.67. About 76% of PD patients were found to have one pain type, 21.7% were having two pain types, and 1.9% had three pain types. Further, 69.8% of these patients were presented with musculoskeletal pain, 4.7% with dystonic pain, 22.6% with radicular-neuropathic pain, 20.8% with central neuropathic pain, and 9.4% with akathisia pain. The onset age and depression were the most significant predictors of pain in PD patients (p < 0.05). However, there was no significant association between pain and gender, age, disease duration, or severity of the disease. Only 5.7% of PD patients with pain received treatment in this study. CONCLUSIONS Pain is frequent and disabling, independent of demographic and clinical variables, and is significantly more common in PD patients.
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105
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Rascol O, Zesiewicz T, Chaudhuri KR, Asgharnejad M, Surmann E, Dohin E, Nilius S, Bauer L. A Randomized Controlled Exploratory Pilot Study to Evaluate the Effect of Rotigotine Transdermal Patch on Parkinson's Disease-Associated Chronic Pain. J Clin Pharmacol 2015; 56:852-61. [PMID: 26626320 DOI: 10.1002/jcph.678] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/06/2015] [Indexed: 12/31/2022]
Abstract
Pain is a troublesome nonmotor symptom of Parkinson's disease (PD). This double-blind exploratory pilot study (NCT01744496) was the first to specifically investigate the effect of a dopamine agonist on PD-associated pain as primary outcome. Patients with advanced PD (ie, receiving levodopa) and at least moderate PD-associated chronic pain (≥3 months, ≥4 points on 11-point Likert pain scale) were randomized to rotigotine (optimal/maximum dose ≤16 mg/24h) or placebo and maintained for 12 weeks. Primary efficacy variable was change in pain severity (Likert pain scale) from baseline to end of maintenance. Secondary variables included percentage of responders (≥2-point Likert pain scale reduction), King's PD Pain Scale (KPPS) domains, and PD Questionnaire (PDQ-8). Statistical analyses were exploratory. Of 68 randomized patients, 60 (rotigotine, 30; placebo, 30) were evaluable for efficacy. A numerical improvement in pain was observed in favor of rotigotine (Likert pain scale: least-squares mean [95%CI] treatment difference, -0.76 [-1.87 to 0.34]; P = .172), and proportion of responders was 18/30 (60%) rotigotine vs 14/30 (47%) placebo. An ∼2-fold numerical improvement in KPPS domain "fluctuation-related pain" was observed with rotigotine vs placebo. Rotigotine improved PDQ-8 vs placebo (-8.01 [-15.56 to -0.46]; P = .038). These results suggest rotigotine may improve PD-associated pain; a large-scale confirmatory study is needed.
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Affiliation(s)
- Olivier Rascol
- Clinical Investigation Center CIC1436 and Department of Clinical Pharmacology and Neurosciences, INSERM, Toulouse University Hospital and University of Toulouse, Toulouse, France
| | - Theresa Zesiewicz
- University of South Florida Ataxia Research Center, The Frances J. Zesiewicz Foundation for Parkinson's Disease at USF, Parkinson's Disease and Movement Disorders Clinic at the PADREC, James A. Haley Veterans' Administration, Tampa, FL, USA
| | - K Ray Chaudhuri
- National Parkinson's Foundation International Centre of Excellence, King's College Hospital, Kings College and Kings Health Partners, London, UK
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Priebe JA, Kunz M, Morcinek C, Rieckmann P, Lautenbacher S. Does Parkinson's disease lead to alterations in the facial expression of pain? J Neurol Sci 2015; 359:226-35. [DOI: 10.1016/j.jns.2015.10.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 10/08/2015] [Accepted: 10/30/2015] [Indexed: 12/13/2022]
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Valkovic P, Minar M, Singliarova H, Harsany J, Hanakova M, Martinkova J, Benetin J. Pain in Parkinson's Disease: A Cross-Sectional Study of Its Prevalence, Types, and Relationship to Depression and Quality of Life. PLoS One 2015; 10:e0136541. [PMID: 26309254 PMCID: PMC4550419 DOI: 10.1371/journal.pone.0136541] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 08/04/2015] [Indexed: 11/18/2022] Open
Abstract
Pain is an important and distressing symptom in Parkinson's disease (PD). Our aim was to determine the prevalence of pain, its various types and characteristics, as well as its impact on depression and quality of life (QoL) in patients with PD. How pain differs in early- and advanced-stage PD and male and female PD patients was of special interest. One hundred PD patients on dopaminergic medications had a neurological examination and participated in a structured interview on pain characteristics and completed standardized questionnaires. A total of 76% of the patients had pain. The following types of pain were present: musculoskeletal pain accounted for 41% of the total pain, dystonic pain for 17%, central neuropathic pain for 22%, radicular pain for 27%, and other pains (non-radicular low back pain, arthritic, and visceral pain) made up 24%. One type of pain affected 29% of all the subjects, two types 35%, three types 10%, and four types of pain were reported by 2%. All types of pain were more prevalent in advanced-stage PD subjects than in early-stage PD subjects, except for arthritic pain (subclassified under"other pain"). The frequency and intensity of actual, average, and worst experienced pain were significantly more severe in advanced-stage subjects. PD subjects with general pain and in advanced stages were more depressed and had poorer QoL. Depression correlated with worst pain in the last 24 hours and with pain periodicity (the worst depression score in patients with constant pain). QoL correlated with average pain in the last 7 days. Pain is a frequent problem in PD patients, and it worsens during the course of the disease.
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Affiliation(s)
- Peter Valkovic
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
- Laboratory of Motor Control, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic
- * E-mail: (PV); (MM)
| | - Michal Minar
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
- * E-mail: (PV); (MM)
| | - Helena Singliarova
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
- Department of Physiatry and Rehabilitation, Ruzinov University Hospital, Bratislava, Slovak Republic
| | - Jan Harsany
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Marta Hanakova
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Jana Martinkova
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Jan Benetin
- Department of Neurology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovak Republic
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Influence of Dopaminergic Medication on Conditioned Pain Modulation in Parkinson's Disease Patients. PLoS One 2015; 10:e0135287. [PMID: 26270817 PMCID: PMC4536013 DOI: 10.1371/journal.pone.0135287] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/20/2015] [Indexed: 01/22/2023] Open
Abstract
Background Pain is highly prevalent in patients with Parkinson’s disease (PD), but little is known about the underlying pathophysiological mechanisms. The susceptibility to pain is known to depend on ascending and descending pathways. Because parts of the descending pain inhibitory system involve dopaminergic pathways, dysregulations in dopaminergic transmission might contribute to altered pain processing in PD. Deficits in endogenous pain inhibition can be assessed using conditioned pain modulation (CPM) paradigms. Methods Applying such a paradigm, we investigated i) whether CPM responses differ between PD patients and healthy controls, ii) whether they are influenced by dopaminergic medication and iii) whether there are effects of disease-specific factors. 25 patients with idiopathic PD and 30 healthy age- and gender-matched controls underwent an established CPM paradigm combining heat pain test stimuli at the forearm and the cold pressor task on the contralateral foot as the conditioning stimulus. PD patients were tested under dopaminergic medication and after at least 12 hours of medication withdrawal. Results No significant differences between CPM responses of PD patients and healthy controls or between PD patients “on” and “off” medication were found. These findings suggest (i) that CPM is insensitive to dopaminergic modulations and (ii) that PD is not related to general deficits in descending pain inhibition beyond the known age-related decline. However, at a trend level, we found differences between PD subtypes (akinetic-rigid, tremor-dominant, mixed) with the strongest impairment of pain inhibition in the akinetic-rigid subtype. Conclusions There were no significant differences between CPM responses of patients compared to healthy controls or between patients “on” and “off” medication. Differences between PD subtypes at a trend level point towards different pathophysiological mechanisms underlying the three PD subtypes which warrant further investigation and potentially differential therapeutic strategies in the future.
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109
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Mylius V, Ciampi de Andrade D, Cury RG, Teepker M, Ehrt U, Eggert KM, Beer S, Kesselring J, Stamelou M, Oertel WH, Möller JC, Lefaucheur JP. Pain in Parkinson's Disease: Current Concepts and a New Diagnostic Algorithm. Mov Disord Clin Pract 2015; 2:357-364. [PMID: 30363602 DOI: 10.1002/mdc3.12217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 12/30/2022] Open
Abstract
Background Pain is a significant burden for patients with Parkinson's disease (PD) with a high impact on quality of life. The present article aims at summarizing epidemiological, pathophysiological, clinical, and neurophysiological data regarding pain in PD. Methods In this domain, a procedure of systematic assessment is still lacking for the syndromic diagnosis and should take into account pain characteristics, effects of dopaminergic treatment, motor fluctuations, and non-PD-associated pain. Findings We propose an original questionnaire addressing an algorithm suitable for daily clinical practice. The questionnaire is based on a three-step approach addressing first the relationship between pain and PD (including temporal relationship with the course of the disease, association with motor fluctuations, and impact of antiparkinsonian treatment), before classifying pain into one of three main syndromes (i.e., musculoskeletal pain, psychomotor restlessness pain, and neuropathic pain). Conclusions The proposed questionnaire allows the characteristics of each pain type to be determined according to its relationship with the disease and its treatment. The validation of the clinical use of this questionnaire will be the goal of a forthcoming work.
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Affiliation(s)
- Veit Mylius
- Department of Neurology Philipps University Marburg Germany.,Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | | | - Rubens Gisbert Cury
- Pain Center Department of Neurology University of São Paulo São Paulo SP Brazil
| | | | - Uwe Ehrt
- Psychiatric Clinic Fachklinikum Bernburg Bernburg Germany
| | | | - Serafin Beer
- Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | - Jürg Kesselring
- Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | - Maria Stamelou
- Department of Neurology Philipps University Marburg Germany.,Movement Disorders Clinic Second Department of Neurology University of Athens Athens Greece
| | | | - Jens Carsten Möller
- Parkinson Center Center for Neurological Rehabilitation Zihlschlacht Switzerland
| | - Jean-Pascal Lefaucheur
- Faculté de Médecine Université Paris Est Créteil Créteil France.,Service de Physiologie-Explorations Fonctionnelles Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris Créteil France
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Cury R, Galhardoni R, Fonoff E, Perez Lloret S, dos Santos Ghilardi M, Barbosa E, Teixeira M, Ciampi de Andrade D. Sensory abnormalities and pain in Parkinson disease and its modulation by treatment of motor symptoms. Eur J Pain 2015; 20:151-65. [DOI: 10.1002/ejp.745] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2015] [Indexed: 01/07/2023]
Affiliation(s)
- R.G. Cury
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Pain Center; Instituto do Câncer do Estado de São Paulo; São Paulo Brazil
- Movement Disorders Group; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - R. Galhardoni
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - E.T. Fonoff
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Transcranial Magnetic Stimulation Laboratory; Psychiatry Institute; University of São Paulo; São Paulo Brazil
- Neurosurgery Division; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - S. Perez Lloret
- Laboratory of Clinical Pharmacology and Epidemiology; Catholic University; Buenos Aires Argentina
| | | | - E.R. Barbosa
- Movement Disorders Group; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - M.J. Teixeira
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Pain Center; Instituto do Câncer do Estado de São Paulo; São Paulo Brazil
- Movement Disorders Group; Department of Neurology; University of São Paulo; São Paulo Brazil
- Transcranial Magnetic Stimulation Laboratory; Psychiatry Institute; University of São Paulo; São Paulo Brazil
- Neurosurgery Division; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - D. Ciampi de Andrade
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Pain Center; Instituto do Câncer do Estado de São Paulo; São Paulo Brazil
- Transcranial Magnetic Stimulation Laboratory; Psychiatry Institute; University of São Paulo; São Paulo Brazil
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112
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Chen Y, Mao CJ, Li SJ, Wang F, Chen J, Zhang HJ, Li L, Guo SS, Yang YP, Liu CF. Quantitative and fiber-selective evaluation of pain and sensory dysfunction in patients with Parkinson's disease. Parkinsonism Relat Disord 2015; 21:361-5. [DOI: 10.1016/j.parkreldis.2015.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/20/2014] [Accepted: 01/11/2015] [Indexed: 11/27/2022]
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113
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Aschermann Z, Nagy F, Perlaki G, Janszky J, Schwarcz A, Kovacs N, Bogner P, Komoly S, Orsi G. ‘Wind-up’ in Parkinson's disease: A functional magnetic resonance imaging study. Eur J Pain 2015; 19:1288-97. [DOI: 10.1002/ejp.659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Z. Aschermann
- Department of Neurology; Faculty of Medicine; University of Pécs; Hungary
| | - F. Nagy
- Department of Neurology; Mór Kaposi County Hospital; Kaposvár Hungary
| | - G. Perlaki
- Diagnostic Centre of Pécs; Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; University of Pécs; Hungary
| | - J. Janszky
- Department of Neurology; Faculty of Medicine; University of Pécs; Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; University of Pécs; Hungary
| | - A. Schwarcz
- MTA-PTE Clinical Neuroscience MR Research Group; University of Pécs; Hungary
- Department of Neurosurgery; Faculty of Medicine; University of Pécs Hungary
| | - N. Kovacs
- Department of Neurology; Faculty of Medicine; University of Pécs; Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; University of Pécs; Hungary
| | | | - S. Komoly
- Department of Neurology; Faculty of Medicine; University of Pécs; Hungary
| | - G. Orsi
- Diagnostic Centre of Pécs; Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; University of Pécs; Hungary
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114
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Haloperidol blocks dorsal striatum activity but not analgesia in a placebo paradigm. Cortex 2014; 57:60-73. [DOI: 10.1016/j.cortex.2014.02.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/08/2013] [Accepted: 02/27/2014] [Indexed: 12/19/2022]
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115
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Ahlskog JE. Parkinson disease treatment in hospitals and nursing facilities: avoiding pitfalls. Mayo Clin Proc 2014; 89:997-1003. [PMID: 24996235 DOI: 10.1016/j.mayocp.2014.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/23/2014] [Accepted: 02/25/2014] [Indexed: 11/19/2022]
Abstract
The unique needs of patients with Parkinson disease challenge staff when such patients are admitted to hospitals or nursing facilities. Prolongation of the hospital stay, falls with injuries, fainting, or declining motor function may result from therapeutic misadventures or failure to anticipate common problems. Staff familiarity with Parkinson disease, and especially carbidopa-levodopa dosing and dynamics, may prevent such problems and streamline hospital and nursing home care.
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116
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Taylor AMW, Murphy NP, Evans CJ, Cahill CM. Correlation between ventral striatal catecholamine content and nociceptive thresholds in neuropathic mice. THE JOURNAL OF PAIN 2014; 15:878-85. [PMID: 25052072 DOI: 10.1016/j.jpain.2014.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Neuropathic pain is characterized by persistent, intractable pain following damage or dysfunction of the nervous system. Analgesics that include central, rather than purely peripheral, targets are more effective when treating neuropathic pain, highlighting the spinal and/or supraspinal mechanisms that contribute to this aberrant pain condition. The striatum represents one of the brain regions that have been implicated in pain processing. Release of dopamine in the ventral striatum is normally associated with analgesia. Clinical and human imaging studies suggest that dopamine is disrupted in neuropathic pain patients, although the conclusions drawn from these studies are limited by their noninvasive imaging or pharmacologic approaches. In this study, we used a C57Bl/6 mouse model of neuropathic pain to describe the changes in neurotransmitter content in the striatum and their relationship to evoked pain thresholds. Striatal dopamine content negatively correlated with mechanical thresholds in sham animals. Neuropathic pain animals had reduced dopamine content that was not correlated with mechanical thresholds. In contrast, norepinephrine content was significantly increased and correlated with mechanical thresholds in neuropathic, but not sham, animals. These results describe changes in striatal signaling in neuropathic pain animals and contribute to the literature defining the role of dopamine and norepinephrine in mediating sensory thresholds in healthy and neuropathic pain states. PERSPECTIVE Results show significant loss of ventral striatal dopamine in neuropathic pain conditions, and the relationship of ventral striatal catecholamines to pain thresholds is changed in neuropathic pain. These results complement human imaging studies and provide evidence that chronic pain alters the function of reward systems.
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Affiliation(s)
- Anna M W Taylor
- Department of Anesthesiology and Perioperative Medicine, University of California, Irvine, California; Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California
| | - Niall P Murphy
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California
| | - Christopher J Evans
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California
| | - Catherine M Cahill
- Department of Anesthesiology and Perioperative Medicine, University of California, Irvine, California.
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Tiemann L, Heitmann H, Schulz E, Baumkötter J, Ploner M. Dopamine precursor depletion influences pain affect rather than pain sensation. PLoS One 2014; 9:e96167. [PMID: 24760082 PMCID: PMC3997524 DOI: 10.1371/journal.pone.0096167] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/03/2014] [Indexed: 01/15/2023] Open
Abstract
Pain is a multidimensional experience, which includes sensory, cognitive, and affective aspects. Converging lines of evidence indicate that dopaminergic neurotransmission plays an important role in human pain perception. However, the precise effects of dopamine on different aspects of pain perception remain to be elucidated. To address this question, we experimentally decreased dopaminergic neurotransmission in 22 healthy human subjects using Acute Phenylalanine and Tyrosine Depletion (APTD). During APTD and a control condition we applied brief painful laser stimuli to the hand, assessed different aspects of pain perception, and recorded electroencephalographic responses. APTD-induced decreases of cerebral dopaminergic activity did not influence sensory aspects of pain perception. In contrast, APTD yielded increases of pain unpleasantness. The increases of unpleasantness ratings positively correlated with effectiveness of APTD. Our finding of an influence of dopaminergic neurotransmission on affective but not sensory aspects of phasic pain suggests that analgesic effects of dopamine might be mediated by indirect effects on pain affect rather than by direct effects on ascending nociceptive signals. These findings contribute to our understanding of the complex relationship between dopamine and pain perception, which may play a role in various clinical pain states.
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Affiliation(s)
- Laura Tiemann
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
- * E-mail:
| | - Henrik Heitmann
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Jochen Baumkötter
- Department of Pediatrics, Technische Universität München, Munich, Germany
| | - Markus Ploner
- Department of Neurology, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
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118
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Zesiewicz TA, Martinez-Martin P. Effects of rotigotine transdermal system on non-motor symptoms in Parkinson’s disease: an overview. Expert Rev Neurother 2014; 13:1329-42. [DOI: 10.1586/14737175.2013.859986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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120
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Abstract
Movement disorders, which include disorders such as Parkinson's disease, dystonia, Tourette's syndrome, restless legs syndrome, and akathisia, have traditionally been considered to be disorders of impaired motor control resulting predominantly from dysfunction of the basal ganglia. This notion has been revised largely because of increasing recognition of associated behavioural, psychiatric, autonomic, and other non-motor symptoms. The sensory aspects of movement disorders include intrinsic sensory abnormalities and the effects of external sensory input on the underlying motor abnormality. The basal ganglia, cerebellum, thalamus, and their connections, coupled with altered sensory input, seem to play a key part in abnormal sensorimotor integration. However, more investigation into the phenomenology and physiological basis of sensory abnormalities, and about the role of the basal ganglia, cerebellum, and related structures in somatosensory processing, and its effect on motor control, is needed.
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Affiliation(s)
- Neepa Patel
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
| | - Mark Hallett
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA
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121
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Ikeda K, Deguchi K, Kume K, Kamada M, Touge T, Masaki T. Assessment of sensory perception and processing using current perception threshold in Parkinson's disease. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/ncn3.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kazuyo Ikeda
- Department of Gastroenterology and Neurology; Kagawa University Faculty of Medicine; Kagawa Japan
- Department of Neurological Intractable Disease Research; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Kazushi Deguchi
- Department of Gastroenterology and Neurology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Kodai Kume
- Department of Gastroenterology and Neurology; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Masaki Kamada
- Department of Neurological Intractable Disease Research; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Tetsuo Touge
- Department of Health Sciences; Kagawa University Faculty of Medicine; Kagawa Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology; Kagawa University Faculty of Medicine; Kagawa Japan
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Becker S, Ceko M, Louis-Foster M, Elfassy NM, Leyton M, Shir Y, Schweinhardt P. Dopamine and pain sensitivity: neither sulpiride nor acute phenylalanine and tyrosine depletion have effects on thermal pain sensations in healthy volunteers. PLoS One 2013; 8:e80766. [PMID: 24236199 PMCID: PMC3827462 DOI: 10.1371/journal.pone.0080766] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/15/2013] [Indexed: 11/30/2022] Open
Abstract
Based on animal studies and some indirect clinical evidence, dopamine has been suggested to have anti-nociceptive effects. Here, we investigated directly the effects of increased and decreased availability of extracellular dopamine on pain perception in healthy volunteers. In Study 1, participants ingested, in separate sessions, a placebo and a low dose of the centrally acting D2-receptor antagonist sulpiride, intended to increase synaptic dopamine via predominant pre-synaptic blockade. No effects were seen on thermal pain thresholds, tolerance, or temporal summation. Study 2 used the acute phenylalanine and tyrosine depletion (APTD) method to transiently decrease dopamine availability. In one session participants ingested a mixture that depletes the dopamine amino acid precursors, phenylalanine and tyrosine. In the other session they ingested a nutritionally balanced control mixture. APTD led to a small mood-lowering response following aversive thermal stimulation, but had no effects on the perception of cold, warm, or pain stimuli. In both studies the experimental manipulation of dopaminergic neurotransmission was successful as indicated by manipulation checks. The results contradict proposals that dopamine has direct anti-nociceptive effects in acute experimental pain. Based on dopamine's well-known role in reward processing, we hypothesize that also in the context of pain, dopamine acts on stimulus salience and might play a role in the initiation of avoidance behavior rather than having direct antinociceptive effects in acute experimental pain.
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Affiliation(s)
- Susanne Becker
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marta Ceko
- National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mytsumi Louis-Foster
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Nathaniel M. Elfassy
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Marco Leyton
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, Quebec, Canada
| | - Yoram Shir
- Alan Edwards Pain Management Unit, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Petra Schweinhardt
- Alan Edwards Centre for Research on Pain and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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123
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124
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Defazio G, Tinazzi M, Berardelli A. How pain arises in Parkinson's disease? Eur J Neurol 2013; 20:1517-23. [DOI: 10.1111/ene.12260] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 08/15/2013] [Indexed: 12/30/2022]
Affiliation(s)
- G. Defazio
- Department of Basic Medical Sciences; Neurosciences and Sense Organs; ‘Aldo Moro’ University of Bari; Bari Italy
| | - M. Tinazzi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences; University of Verona; Verona Italy
| | - A. Berardelli
- Department of Neurology and Psychiatry; Sapienza University of Rome and Neuromed Institute; IRCCS; Rome Italy
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125
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Perrotta A, Bolla M, Serrao M, Paparatti M, Tassorelli C, Pierelli F, Sandrini G. Enhanced temporal pain processing in multiple system atrophy. Neurosci Lett 2013; 555:203-8. [DOI: 10.1016/j.neulet.2013.09.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/26/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
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126
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Granovsky Y, Schlesinger I, Fadel S, Erikh I, Sprecher E, Yarnitsky D. Asymmetric pain processing in Parkinson's disease. Eur J Neurol 2013; 20:1375-82. [DOI: 10.1111/ene.12188] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/08/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - S. Fadel
- Department of Neurology; Rambam Health Care Campus; Haifa; Israel
| | - I. Erikh
- Department of Neurology; Rambam Health Care Campus; Haifa; Israel
| | - E. Sprecher
- Department of Neurology; Rambam Health Care Campus; Haifa; Israel
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127
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Navratilova E, Xie JY, King T, Porreca F. Evaluation of reward from pain relief. Ann N Y Acad Sci 2013; 1282:1-11. [PMID: 23496247 DOI: 10.1111/nyas.12095] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The human experience of pain is multidimensional and comprises sensory, affective, and cognitive dimensions. Preclinical assessment of pain has been largely focused on the sensory features that contribute to nociception. The affective (aversive) qualities of pain are clinically significant but have received relatively less mechanistic investigation in preclinical models. Recently, operant behaviors such as conditioned place preference, avoidance, escape from noxious stimulus, and analgesic drug self-administration have been used in rodents to evaluate affective aspects of pain. An important advance of such operant behaviors is that these approaches may allow the detection and mechanistic investigation of spontaneous neuropathic or ongoing inflammatory/nociceptive (i.e., nonevoked) pain that is otherwise difficult to assess in nonverbal animals. Operant measures may allow the identification of mechanisms that contribute differentially to reflexive hypersensitivity or to pain affect and may inform the decision to progress novel mechanisms to clinical trials for pain therapy. Additionally, operant behaviors may allow investigation of the poorly understood mechanisms and neural circuits underlying motivational aspects of pain and the reward of pain relief.
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Affiliation(s)
- Edita Navratilova
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ 85724, USA
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128
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Fil A, Cano-de-la-Cuerda R, Muñoz-Hellín E, Vela L, Ramiro-González M, Fernández-de-las-Peñas C. Pain in Parkinson disease: A review of the literature. Parkinsonism Relat Disord 2013; 19:285-94; discussion 285. [DOI: 10.1016/j.parkreldis.2012.11.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/07/2012] [Accepted: 11/22/2012] [Indexed: 11/28/2022]
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129
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Pain perception in patients with Parkinson's disease. J Clin Neurosci 2013; 20:663-6. [PMID: 23485408 DOI: 10.1016/j.jocn.2012.05.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 05/15/2012] [Accepted: 05/19/2012] [Indexed: 10/27/2022]
Abstract
Abnormalities in pain perception are a part of the clinical picture in Parkinson's disease (PD) and belong to the category of non-motor symptoms. Two groups of patients were included in this study: (i) an experimental group of 36 patients with PD who were eligible for subthalamic deep brain stimulation (the experimental group [EG]) and (ii) a control group (CG) of 34 patients with a space-occupying lesion who were admitted for a framed stereotactic biopsy. Stereotactic frame fixation was used in both groups as a nociceptive stimulus. All participants were assessed for pain perception with two kinds of visual analogue scales (VAS) (a non-color VAS [ncVAS] and a color VAS [cVAS]) immediately after the stimulus (EG - ncVAS 1 and cVAS 1; CG - ncVAS 3 and cVAS 3) and 24 hours later (EG - ncVAS 2 and cVAS 2; CG - ncVAS 4 and cVAS 4). The means for the two pain scores assessed directly after frame fixation were 3.59 (ncVAS 1) and 3.06 (cVAS 1) for patients in the EG, while the mean ncVAS was 3, and the mean cVAS 3 was 6.1 for those in the CG. The pain intensity was significantly lower for patients with PD (EG) compared to those in the CG for both ncVAS and cVAS (p<0.05 for each measure). The mean pain scores for ncVAS and cVAS measured 24 hours after the procedure were 3.18 and 2.79 for patients with PD (EG) and 6.10 and 5.77 for those in the CG, respectively. Pain intensity measured 24 hours after the procedure was significantly lower in those with PD (EG) compared to the CG. This study has demonstrated that pain perception in patients with PD is significantly lower than pain perception in non-parkinsonian patients.
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130
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Brefel-Courbon C, Ory-Magne F, Thalamas C, Payoux P, Rascol O. Nociceptive brain activation in patients with neuropathic pain related to Parkinson's disease. Parkinsonism Relat Disord 2013; 19:548-52. [PMID: 23462484 DOI: 10.1016/j.parkreldis.2013.02.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/04/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients suffering from Parkinson's disease (PD) frequently experience painful sensations that may be due to central modification of nociception in PD. We compared pain thresholds and cerebral activity in nociceptive areas using Positron Emission Tomography (PET) during nociceptive stimulation before (OFF condition) and after (ON condition) levodopa challenge between nine PD patients with and nine PD patients without neuropathic pain. METHODS Pain thresholds were determined using a cold pressor test in the two conditions. We used H2(15)O PET to study the regional cerebral blood flow changes in subjects while they received alternate randomized noxious and innocuous cold stimuli during OFF and ON periods. RESULTS Pain thresholds were not significantly different between PD patients with and without pain in either condition (OFF and ON). In both groups of PD patients, levodopa significantly raised pain threshold (F1,16 = 26.71; p < 0.0001) with a mean variation of -2.7 (±2.3 °C). In the OFF condition, PD patients with pain had a lower pain activation in the right prefrontal cortex and posterior insula and a higher pain activation in the right anterior cingulate cortex (BA32/8) than pain-free patients. Levodopa significantly reduced pain-induced-activation in the right insula and in the anterior cingulate cortex in both groups. CONCLUSION Levodopa decreased nociceptive perception in both PD patients with and without pain. In PD patients with neuropathic pain the medial affective pathway was preferentially recruited whereas pain-free PD patients exhibited a greater activation in lateral discriminative nociceptive areas.
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Affiliation(s)
- Christine Brefel-Courbon
- Inserm, Imagerie cérébrale et handicaps neurologiques, UMR 825, F-31059 Toulouse, France - Université de Toulouse, UPS, Imagerie cérébrale et handicaps neurologiques, F-31059 Toulouse, France.
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131
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Abstract
Pain is a common symptom in Parkinson's disease (PD) and accounts for substantial morbidity in up to 80 % of patients. Despite contributing to disease-related discomfort and disability, pain in PD frequently goes underacknowledged and undertreated in clinical practice. Although the exact underlying neurophysiology is unclear, there is increasing understanding of the role of the basal ganglia in somatosensory processing, as well as involvement of additional brainstem structures and non-dopaminergic pathways; appreciation of these mechanisms has implications for treatment strategies. Categorizing painful symptoms based on their clinical description into musculoskeletal, dystonic, radicular-peripheral neuropathic and central pain categories provides a useful framework for management. Importantly, these symptoms should be evaluated in relation to motor symptoms and dopaminergic therapy. A multi-disciplinary approach is recommended as follows: physical therapy, liaison with pain management and consultations to rheumatological, orthopaedic and neurosurgical services should be considered.
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Affiliation(s)
- Munazza Sophie
- Department of Neurology, Columbia University, New York, NY, USA
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132
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133
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Dellapina E, Ory-Magne F, Regragui W, Thalamas C, Lazorthes Y, Rascol O, Payoux P, Brefel-Courbon C. Effect of subthalamic deep brain stimulation on pain in Parkinson's disease. Pain 2012; 153:2267-2273. [PMID: 22964434 DOI: 10.1016/j.pain.2012.07.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 07/18/2012] [Accepted: 07/24/2012] [Indexed: 01/29/2023]
Abstract
Painful sensations are common in Parkinson's disease. In many patients, such sensations correspond to neuropathic pain and could be related to central alterations of pain processing. Subthalamic nuclei deep brain stimulation improves motor function in Parkinson's disease. Several structures of the basal ganglia are involved in nociceptive function, and deep brain stimulation could thus also modify pain perception in Parkinson's disease. To test this hypothesis, we compared subjective heat pain thresholds, in deep brain stimulation OFF and ON conditions in 2 groups of Parkinson's disease patients with or without neuropathic pain. We also compared pain-induced cerebral activations during experimental nociceptive stimulations using H(2)(15)O positron emission tomography in both deep brain stimulation OFF and ON conditions. Correlation analyses were performed between clinical and neuroimaging results. Deep brain stimulation significantly increased subjective heat pain threshold (from 40.3 ± 4.2 to 41.6 ± 4.3, P=.03) and reduced pain-induced cerebral activity in the somatosensory cortex (BA 40) in patients with pain, whereas it had no effect in pain-free patients. There was a significant negative correlation in the deep brain stimulation OFF condition between pain threshold and pain-induced activity in the insula of patients who were pain free but not in those who had pain. There was a significant positive correlation between deep brain stimulation-induced changes in pain threshold and in pain-induced cerebral activations in the primary somatosensory cortex and insula of painful patients only. These results suggest that subthalamic nuclei deep brain stimulation raised pain thresholds in Parkinson's disease patients with pain and restored better functioning of the lateral discriminative pain system.
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Affiliation(s)
- Estelle Dellapina
- INSERM, Imagerie cérébrale et handicaps neurologiques, Toulouse, France Université de Toulouse, Imagerie cérébrale et handicaps neurologiques, Toulouse, France Department of Neurology, University Hospital of Toulouse, Toulouse, France INSERM, Clinical Investigation Center, Purpan, Toulouse, France Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France Department of Clinical Pharmacology, University of Medicine, Toulouse, France
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134
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Vela L, Cano-de-la-Cuerda R, Fil A, Muñoz-Hellín E, Ortíz-Gutiérrez R, Macías-Macías Y, Fernández-de-las-Peñas C. Thermal and mechanical pain thresholds in patients with fluctuating Parkinson's disease. Parkinsonism Relat Disord 2012; 18:953-7. [DOI: 10.1016/j.parkreldis.2012.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 04/26/2012] [Accepted: 04/29/2012] [Indexed: 11/29/2022]
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135
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Borgohain R, Kandadai RM, Jabeen A, Kannikannan MA. Nonmotor outcomes in Parkinson's disease: is deep brain stimulation better than dopamine replacement therapy? Ther Adv Neurol Disord 2012; 5:23-41. [PMID: 22276074 DOI: 10.1177/1756285611423412] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nonmotor symptoms are an integral part of Parkinson's disease and cause significant morbidity. Pharmacological therapy helps alleviate the disease but produces nonmotor manifestations. While deep brain stimulation (DBS) has emerged as the treatment of choice for motor dysfunction, the effect on nonmotor symptoms is not well known. Compared with pharmacological therapy, bilateral subthalamic nucleus (STN)-DBS or globus pallidum interna (GPi)-DBS has significant beneficial effects on pain, sleep, gastrointestinal and urological symptoms. STN-DBS is associated with a mild worsening in verbal fluency while GPi-DBS has no effect on cognition. STN-DBS may improve cardiovascular autonomic disturbances by reducing the dose of dopaminergic drugs. Because the motor effects of STN-DBS and GPi-DBS appear to be similar, nonmotor symptoms may determine the target choice in surgery of future patients.
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136
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Perez-Lloret S, Rey MV, Dellapina E, Pellaprat J, Brefel-Courbon C, Rascol O. Emerging analgesic drugs for Parkinson's disease. Expert Opin Emerg Drugs 2012; 17:157-71. [DOI: 10.1517/14728214.2012.677949] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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137
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Wasner G, Deuschl G. Pains in Parkinson disease—many syndromes under one umbrella. Nat Rev Neurol 2012; 8:284-94. [DOI: 10.1038/nrneurol.2012.54] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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138
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Greenbaum L, Tegeder I, Barhum Y, Melamed E, Roditi Y, Djaldetti R. Contribution of genetic variants to pain susceptibility in Parkinson disease. Eur J Pain 2012; 16:1243-50. [PMID: 22473870 DOI: 10.1002/j.1532-2149.2012.00134.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pain is a one of the most disturbing non-motor symptoms of Parkinson disease (PD). The susceptibility to pain varies substantially among patients with PD. The aim of this study was to assess a potential association of genetic variants to PD-related pain. METHODS We analysed 20 candidate SNPs from 12 genes previously reported to be associated with various pain phenotypes in a homogeneous group of 229 Israeli Jewish PD patients, with and without pain (n = 165 and 64, respectively). RESULTS The statistical analysis accounted for the potential influence of demographic and clinical factors. The non-synonymous rs6746030 single nucleotide polymorphism (SNP) of the SCN9A gene, which alters the coding sequence of the sodium channel Nav1.7 (arginine to tryptophan), was nominally associated with PD-related pain susceptibility (p = 0.037), as well as with central and musculoskeletal pain subtypes independently. The synonymous rs324419 SNP of the FAAH gene which encodes fatty acid amide hydrolase, a cannabinoid metabolizing enzyme, was associated with PD-related pain (p = 0.006) and specifically with the musculoskeletal subtype. The FAAH haplotype of rs324419 and rs2295633 SNPs, which was previously associated with the variability in pain response in humans, was also associated with PD-related pain (p = 0.012) and specifically with PD-related musculoskeletal pain. CONCLUSIONS Variants within in the SCN9A and FAAH genes were associated with the risk of pain in PD patients. These findings may contribute to our understanding of pain mechanisms of PD and to direct future therapies.
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Affiliation(s)
- L Greenbaum
- Laboratory of Biological Psychiatry, Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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139
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Jarcho JM, Mayer EA, Jiang ZK, Feier NA, London ED. Pain, affective symptoms, and cognitive deficits in patients with cerebral dopamine dysfunction. Pain 2012; 153:744-754. [PMID: 22386471 DOI: 10.1016/j.pain.2012.01.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/29/2011] [Accepted: 01/04/2012] [Indexed: 11/18/2022]
Abstract
Converging preclinical, and human epidemiological, neuroimaging, and genetic evidence suggests a central role for dopamine neurotransmission in modulating pain perception and analgesia. Dysregulation in dopamine signaling may modulate the experience of pain both directly, by enhancing or diminishing the propagation of nociceptive signals, and indirectly, by influencing affective and cognitive processes, which affect the expectation, experience, and interpretation of nociceptive signals. Hypersensitivity to pain and high rates of comorbid chronic pain are common in disorders linked with deficits in dopamine system function, including disorders of mood and affect, substance abuse, and Parkinson disease. Hyposensitivity to pain, however, is common in patients with schizophrenia, which has been linked with excessive dopamine neurotransmission. Although patients are typically affected most by the primary symptoms of their disorders, alterations in pain perception may further increase the burden of their illness, compromising their quality of life. The present review focuses on this relationship, and discusses clinical and potential therapeutic implications for both patients with dopamine-related disorders and those with chronic pain syndromes.
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Affiliation(s)
- Johanna M Jarcho
- National Institute of Mental Health, Bethesda, MD, USA Department of Medicine, Oppenheimer Family Center for Neurobiology of Stress, University of California, Los Angeles, CA, USA Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA Brain Research Institute, University of California, Los Angeles, CA, USA
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140
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Barceló AC, Filippini B, Pazo JH. The striatum and pain modulation. Cell Mol Neurobiol 2012; 32:1-12. [PMID: 21789630 DOI: 10.1007/s10571-011-9737-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 07/02/2011] [Indexed: 10/18/2022]
Abstract
The aim of this review was to give a general aspect of the sensorial function of the striatum related to pain modulation, which was intensively studied in our laboratory. We analyse the effect of electrical and chemical stimulation of the striatum on the orofacial pain, especially that produced by tooth pulp stimulation of the lower incisors. We demonstrated specific sites within the nucleus which electrical or chemical stimulation produced inhibition of the nociceptive jaw opening reflex. This analgesic action of the striatum was mediated by activation of its dopamine D(2) receptors and transmitted through the indirect pathways of the basal ganglia and the medullary dorsal reticular nucleus (RVM) to the sensorial nuclei of the trigeminal nerve. Its mechanism of action was by inhibition of the nociceptive response of the second order neurons of the nucleus caudalis of the V par.
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Affiliation(s)
- Ana C Barceló
- Facultad de Odontología, Universidad de Buenos Aires, Cátedra de Fisiología, Buenos Aires, Argentina
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141
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AGARI T, DATE I. Spinal Cord Stimulation for the Treatment of Abnormal Posture and Gait Disorder in Patients With Parkinson's Disease. Neurol Med Chir (Tokyo) 2012; 52:470-4. [DOI: 10.2176/nmc.52.470] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Takashi AGARI
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, and Okayama University Hospital
| | - Isao DATE
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, and Okayama University Hospital
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142
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Abstract
Chronic pain is a frequent component of many neurological disorders, affecting 20-40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain.
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Affiliation(s)
- David Borsook
- MD Center for Pain and the Brain C/O Brain Imaging Center, McLean Hospital Belmont, MA 02478, USA.
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143
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Müller T, Muhlack S, Woitalla D. Pain perception, pain drug therapy and health status in patients with Parkinson's disease. Neuroepidemiology 2011; 37:183-7. [PMID: 22057029 DOI: 10.1159/000331911] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is traditionally characterized as a movement disorder; however, sensory perception problems including pain syndromes are also frequent. We performed a survey to analyze the relations between health status, pain perception and gender in 4,086 PD patients. Moreover, the participants should tick whether they took pain medications or not. SUBJECTS AND METHODS The questionnaire included the EQ-5D and visual analogue scales (VAS) on pain, which asked for mean (VAS A), most (VAS B), and minimal (VAS C) intensity of pain during an interval of 4 weeks prior to the completion of the survey. RESULTS PD patients were divided into three groups according to their EQ-5D total score (I: <8; II: 8-9; III: 10-15). An impairment of health status occurred in relation to the increase in pain syndromes in PD patients. There was a significant increase in VAS scores in relation to the EQ-5D group membership. Female patients reported more on pain and more frequently received a pain drug treatment than male patients. Significant associations were found between the VAS and the EQ-5D scores, and the correlation coefficients were higher in men than in women. CONCLUSIONS Pain is associated with the health status of PD patients and worsens it. More female than male PD patients have to deal with handling of pain and pain drug treatment.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
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144
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Pain in Parkinson's disease. Mov Disord 2011; 27:485-91. [DOI: 10.1002/mds.23959] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 08/22/2011] [Accepted: 08/25/2011] [Indexed: 11/07/2022] Open
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145
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Oshima H, Katayama Y, Morishita T, Sumi K, Otaka T, Kobayashi K, Suzuki Y, Fukaya C, Yamamoto T. Subthalamic nucleus stimulation for attenuation of pain related to Parkinson disease. J Neurosurg 2011; 116:99-106. [PMID: 21905799 DOI: 10.3171/2011.7.jns11158] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this study was to evaluate the efficacy of chronic subthalamic nucleus (STN) stimulation for alleviating pain related to Parkinson disease (PD). METHODS Among 163 consecutive patients undergoing STN stimulation, 69 were identified as experiencing pain preoperatively that was related to their PD. All 69 patients suffering from pain were followed up prospectively for 12 months after surgery. All patients described the severity of their pain according to a visual analog scale (VAS) preoperatively and at 2 weeks, 6 months, and 12 months postoperatively. Pain unrelated to PD was not studied. RESULTS Several types of pain related to PD, the categories of which were based on a modification of 2 previous classifications (Ford and Honey), can occur in such patients: 1) musculoskeletal pain, 2) dystonic pain, 3) somatic pain exacerbated by PD, 4) radicular/peripheral neuropathic pain, and 5) central pain. The overall mean VAS score was significantly decreased postoperatively by 75% and 69% at 2 weeks and 6 months, respectively (p < 0.001). The mean VAS score at 12 months was also decreased by 80%, but 6 instances of pain (3 reports of somatic back pain and 3 reports of radicular/peripheral neuropathic pain) required additional spinal surgery to alleviate the pain severity. The results were analyzed using the Wilcoxon signed-rank test and demonstrated a significant reduction in VAS scores at all follow-up assessments (p < 0.001). Musculoskeletal pain and dystonic pain were well alleviated by STN stimulation. In contrast, somatic pain exacerbated by PD and peripheral neuropathic pain originating from lumbar spinal diseases, such as spondylosis deformans and/or canal stenosis, often deteriorated postoperatively despite attenuation of the patients' motor disability. Patients with central pain were poor responders. CONCLUSIONS This study found that STN stimulation produced significant improvement of overall pain related to PD in patients with advanced PD, and the efficacy continued for at least 1 year. The present results indicate that musculoskeletal pain and dystonic pain responded well to STN stimulation, but patients with back pain (somatic pain) and radicular/peripheral neuropathic pain originating from spinal disease have a potential risk for postoperative deterioration of their pain.
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Affiliation(s)
- Hideki Oshima
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
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146
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Mylius V, Brebbermann J, Dohmann H, Engau I, Oertel WH, Möller JC. Pain sensitivity and clinical progression in Parkinson's disease. Mov Disord 2011; 26:2220-5. [PMID: 21766333 DOI: 10.1002/mds.23825] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/05/2011] [Accepted: 05/12/2011] [Indexed: 11/06/2022] Open
Abstract
Pain sensitivity in Parkinson's disease is known to be altered in an L-dopa-dependent manner with increased spinal nociception and experimental pain perception in the medication-defined "off" state. As Parkinson's disease-related pain can be an early symptom in Parkinson's disease, the present study aimed to investigate experimental pain sensitivity and spinal nociception during clinical progression. The nociceptive flexion reflex as a marker of spinal nociception as well as electrical and heat pain thresholds were assessed during the medication-defined "off" state in 29 patients with Parkinson's disease divided into 3 severity groups (according to their Unified Parkinson's Disease Rating Scale motor score) and compared with 27 healthy elderly subjects. Parkinson's disease-related pain was also quantified. Data provided evidence that spinal nociception and pain sensitivity are preserved during the early phase of Parkinson's disease. Following increased spinal nociception (F(1,36) = 6.838, P = .013), experimental thermal and electrical pain sensitivity were augmented during the course of Parkinson's disease (F(1,34) = 5.397, P = .014; F(1,34) = 6.038, P = 0.053), whereas spinal nociception further increased (F(1,34) = 5.397, P < .001). Increased experimental pain sensitivity was observed in patients exhibiting Parkinson's disease-related pain. Spinal alterations either on the local level or induced by diminished dopaminergic descending inhibition probably led to increased pain sensitivity in later stages. Because Parkinson's disease-related pain is correlated with experimental pain sensitivity these 2 observations likely reflect a causal relation.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Philipps University, Marburg, Germany.
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147
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Leknes S. The pain modulatory cocktail. Scand J Pain 2011; 2:105-107. [DOI: 10.1016/j.sjpain.2011.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Siri Leknes
- University of Oslo , Forskningsveien 3A, Postboks 1094 Blindern , Oslo , Norway
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148
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Gierthmühlen J, Wasner G. Reply: The influence of deep brain stimulation and levodopa on pain perception in Parkinson's disease-implications for further scientific and clinical work. Mov Disord 2011. [DOI: 10.1002/mds.23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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149
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Perrotta A, Sandrini G, Serrao M, Buscone S, Tassorelli C, Tinazzi M, Zangaglia R, Pacchetti C, Bartolo M, Pierelli F, Martignoni E. Facilitated temporal summation of pain at spinal level in Parkinson's disease. Mov Disord 2010; 26:442-8. [PMID: 21462260 DOI: 10.1002/mds.23458] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/15/2010] [Accepted: 09/03/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pain is one of the major nonmotor symptoms of Parkinson's disease. We hypothesized that Parkinson's disease patients could show an early diffuse abnormal processing of the nociceptive inputs also in the absence of clinical pain syndrome and that this could represent the physiopathological substrate to explain the high incidence of diffuse pain symptoms. MATERIALS AND METHODS We used the temporal summation threshold of the nociceptive withdrawal reflex and the related pain sensation to evaluate the facilitation in pain processing at spinal level. Fifteen (7 Women; 8 Men; mean age 63.0 ± 9.1) Parkinson's disease patients without clinical pain and 12 (6 Women, 6 Men; mean age 61.2 ± 4.2) healthy subjects were recruited. Parkinson's disease group has been subdivided into two subgroups, 7 early-stage Parkinson's disease patients with unilateral signs (Hoehn and Yahr stage 1) and 8 patients in a more advanced stage of the disease showing bilateral parkinsonian signs (Hoehn and Yahr stages 2 and 2.5), both "on" and "off" treatments with levodopa. RESULTS A significant facilitation in temporal summation of pain (reduced temporal summation threshold and increased painful sensation) was found in Parkinson's disease patients when compared with controls. This facilitation is more evident in Parkinson's disease with bilateral signs and on the side more affected in Parkinson's disease with unilateral signs. Levodopa administration failed to significantly modify the neurophysiological abnormalities; however, a slight improvement has been detected. CONCLUSIONS The increased gain in pain processing at spinal level in Parkinson's disease patients could be a consequence of the degenerative phenomena involving supraspinal projections implicated in the modulation of pain processing and could make Parkinson's disease patients more predisposed to develop a pain condition.
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Affiliation(s)
- Armando Perrotta
- Department of Neurology, IRCCS C. Mondino Institute of Neurology Foundation, University of Pavia, Pavia, Italy.
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150
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Spontaneous pain, pain threshold, and pain tolerance in Parkinson's disease. J Neurol 2010; 258:627-33. [PMID: 21082324 DOI: 10.1007/s00415-010-5812-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 10/18/2010] [Indexed: 12/30/2022]
Abstract
The mechanisms underlying pain in Parkinson's disease (PD) are unclear. Although a few studies have reported that PD patients may have low pain threshold and tolerance, none could accurately assess whether there was a correlation between sensory thresholds and demographic/clinical features of PD patients. Thus, tactile threshold, pain threshold, and pain tolerance to electrical stimuli in the hands and feet were assessed in 106 parkinsonian patients (of whom 66 reported chronic pain) and 51 age- and sex-matched healthy subjects. Linear regression models determined relationships between psychophysical parameters and demographic/clinical features. Female gender, severity of disease, medical disease associated with painful symptoms, and dyskinesia were more frequently observed in PD patients experiencing pain, even though dyskinesia did not reach significance. Pain threshold and pain tolerance were significantly lower in PD patients than in control subjects, whereas the tactile threshold yielded comparable values in both groups. Multivariable linear regression analyses yielded significant inverse correlations of pain threshold and pain tolerance with motor symptom severity and Beck depression inventory. Pain threshold and pain tolerance did not differ between PD patients with and without pain. In the former group, there was no relationship between pain threshold and the intensity/type of pain, and number of painful body parts. These findings suggest that pain threshold and pain tolerance tend to decrease as PD progresses, which can predispose to pain development. Female gender, dyskinesia, medical conditions associated with painful symptoms, and postural abnormalities secondary to rigidity/bradikinesia may contribute to the appearance of spontaneous pain in predisposed subjects.
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