1
|
Bannister K, Smith RV, Wilkins P, Cummins TM. Towards optimising experimental quantification of persistent pain in Parkinson's disease using psychophysical testing. NPJ Parkinsons Dis 2021; 7:28. [PMID: 33731723 PMCID: PMC7969752 DOI: 10.1038/s41531-021-00173-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
People with Parkinson's disease (PD) may live for multiple decades after diagnosis. Ensuring that effective healthcare provision is received across the range of symptoms experienced is vital to the individual's wellbeing and quality of life. As well as the hallmark motor symptoms, PD patients may also suffer from non-motor symptoms including persistent pain. This type of pain (lasting more than 3 months) is inconsistently described and poorly understood, resulting in limited treatment options. Evidence-based pain remedies are coming to the fore but therapeutic strategies that offer an improved analgesic profile remain an unmet clinical need. Since the ability to establish a link between the neurodegenerative changes that underlie PD and those that underlie maladaptive pain processing leading to persistent pain could illuminate mechanisms or risk factors of disease initiation, progression and maintenance, we evaluated the latest research literature seeking to identify causal factors underlying persistent pain in PD through experimental quantification. The majority of previous studies aimed to identify neurobiological alterations that could provide a biomarker for pain/pain phenotype, in PD cohorts. However heterogeneity of patient cohorts, result outcomes and methodology between human psychophysics studies overwhelmingly leads to inconclusive and equivocal evidence. Here we discuss refinement of pain-PD paradigms in order that future studies may enhance confidence in the validity of observed effect sizes while also aiding comparability through standardisation. Encouragingly, as the field moves towards cross-study comparison of data in order to more reliably reveal mechanisms underlying dysfunctional pain processing, the potential for better-targeted treatment and management is high.
Collapse
Affiliation(s)
- Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Rory V Smith
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Patrick Wilkins
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Tatum M Cummins
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
2
|
Sung S, Vijiaratnam N, Chan DWC, Farrell M, Evans AH. Parkinson disease: A systemic review of pain sensitivities and its association with clinical pain and response to dopaminergic stimulation. J Neurol Sci 2018; 395:172-206. [PMID: 30401469 DOI: 10.1016/j.jns.2018.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/15/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
Patients with Parkinson disease (PD) experience hyperalgesia on evoked pain sensitivity testing, although the relationship of this with persistent pain in PD is less certain. Studies examining this have generated contradictory findings. Further, the role of dopaminergic deficiency as an underlying substrate for hyperalgesia is controversial. We report the results of meta-analyses of the PD pain sensitivity literature in an attempt to answer these questions. We identified 429 records, of which ten articles compared pain sensitivity between PD patients that experienced clinical pain (PDP) to those who did not (PDNP), and twenty studies that examined the effect of dopaminergic medications on pain sensitivity in PD patients. PDP patients experienced a moderate increase in pain sensitivity, had more severe disease, required higher dosages of medication, and were more likely to be female when compared to those PDNP patients. PD patients also had reduced pain sensitivity when tested on dopaminergic medications compared to when they were not on medications. Overall, the results of this systematic review and meta-analysis supports the hypothesis that hyperalgesia contributes to clinical pain in PD, and that the underlying mechanism may be dopaminergically driven.
Collapse
Affiliation(s)
- Simon Sung
- Movement Disorders Service, Department of Neurology, the Royal Melbourne Hospital, Grattan St Parkville 3050, Australia; Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia
| | - Nirosen Vijiaratnam
- Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia
| | - Daniela Wan Chi Chan
- Department of Endocrinology, Barwon Health, Bellerine St, Geelong, VIC 3220, Australia
| | - Michael Farrell
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, 10 Chancellors Walk, Clayton Campus, VIC 3800, Australia
| | - Andrew H Evans
- Movement Disorders Service, Department of Neurology, the Royal Melbourne Hospital, Grattan St Parkville 3050, Australia.
| |
Collapse
|
3
|
Nascimento GC, Bariotto-dos-Santos K, Leite-Panissi CRA, Del-Bel EA, Bortolanza M. Nociceptive Response to l-DOPA-Induced Dyskinesia in Hemiparkinsonian Rats. Neurotox Res 2018; 34:799-807. [DOI: 10.1007/s12640-018-9896-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/17/2022]
|
4
|
Sung S, Vijiaratnam N, Chan DWC, Farrell M, Evans AH. Pain sensitivity in Parkinson's disease: Systematic review and meta-analysis. Parkinsonism Relat Disord 2017; 48:17-27. [PMID: 29398491 DOI: 10.1016/j.parkreldis.2017.12.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/22/2017] [Accepted: 12/25/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pain is a common and disabling non-motor symptom of Idiopathic Parkinson's disease (PD) but its underlying pathophysiological mechanisms are not well understood. There is evidence to suggest that altered pain sensitivity may contribute to the experience of pain in PD patients, but clinical studies investigating this have yielded inconsistent results. OBJECTIVES To examine whether pain thresholds are altered in PD patients compared to normal healthy controls (HC), via the use of systematic review and meta-analysis. DATA SOURCES A systematic search of the MEDLINE and EMBASE library from 1966 to April 2015. STUDY SELECTION Studies that compared pain thresholds in PD patients versus HC were included in the systematic review. Additionally, data comparing PD patients off dopaminergic medications (PDMoff) to HC off medications (HCMoff) were pooled for meta-analysis by pain modality. MAIN OUTCOMES Heat pain threshold, cold pain threshold, electrical pain threshold, nociceptive withdrawal reflex threshold, pressure pain threshold, and pain ratings. RESULTS 22 studies were reviewed, comprising of 616 PD and 451 HC. In the comparison of PDMoff versus HCMoff, a large majority of trials (15/19) found reduced pain thresholds (increased pain sensitivity) in PD patients. Meta-analysis of these trials revealed significantly reduced pain thresholds, of moderate to large effect size, in PD patients across all pain modalities. Results were much more heterogenous when PD patients on medications were compared with HC off medications, with most trials reporting no significant difference in pain thresholds between groups. No significant differences were found in pain thresholds for trials that compared PD patients on medications and HC on medications. CONCLUSION PD patients are more sensitive to noxious stimuli compared to HC when tested in the off medication state. This increase in pain sensitivity is observed across all modalities, but is not as apparent when PD patients are administered Levodopa, suggesting that dopamine deficient states may contribute to hyperalgesia. However, it remains to be seen whether or not increased pain sensitivity translates clinically into increased prevalence of pain. Similarly, it is unclear if dopaminergic medications influence pain sensitivity. Performing a meta-analysis on studies comparing pain thresholds in PD patients with and without pain, and on and off dopaminergic medications, may draw more definitive conclusions in this regard.
Collapse
Affiliation(s)
- Simon Sung
- Movement Disorders Service, Department of Neurology, The Royal Melbourne Hospital, Grattan, St Parkville, 3050, Australia; Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia.
| | - Nirosen Vijiaratnam
- Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia
| | - Daniela Wan Chi Chan
- Department of Endocrinology, Barwon Health, Bellerine St, Geelong, VIC, 3220, Australia
| | - Michael Farrell
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, 10 Chancellors Walk, Clayton Campus, Victoria 3800, Australia
| | - Andrew H Evans
- Movement Disorders Service, Department of Neurology, The Royal Melbourne Hospital, Grattan, St Parkville, 3050, Australia
| |
Collapse
|
5
|
Thompson T, Gallop K, Correll CU, Carvalho AF, Veronese N, Wright E, Stubbs B. Pain perception in Parkinson's disease: A systematic review and meta-analysis of experimental studies. Ageing Res Rev 2017; 35:74-86. [PMID: 28179128 DOI: 10.1016/j.arr.2017.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 01/05/2023]
Abstract
While hyperalgesia (increased pain sensitivity) has been suggested to contribute to the increased prevalence of clinical pain in Parkinson's disease (PD), experimental research is equivocal and mechanisms are poorly understood. We conducted a meta-analysis of studies comparing PD patients to healthy controls (HCs) in their response to experimental pain stimuli. Articles were acquired through systematic searches of major databases from inception until 10/2016. Twenty-six studies met inclusion criteria, comprising 1292 participants (PD=739, HCs=553). Random effects meta-analysis of standardized mean differences (SMD) revealed lower pain threshold (indicating hyperalgesia) in PD patients during unmedicated OFF states (SMD=0.51) which was attenuated during dopamine-medicated ON states (SMD=0.23), but unaffected by age, PD duration or PD severity. Analysis of 6 studies employing suprathreshold stimulation paradigms indicated greater pain in PD patients, just failing to reach significance (SMD=0.30, p=0.06). These findings (a) support the existence of hyperalgesia in PD, which could contribute to the onset/intensity of clinical pain, and (b) implicate dopamine deficiency as a potential underlying mechanism, which may present opportunities for the development of novel analgesic strategies.
Collapse
|
6
|
Electrophysiological assessment of nociception in patients with Parkinson's disease: A multi-methods approach. J Neurol Sci 2016; 368:59-69. [DOI: 10.1016/j.jns.2016.06.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 11/21/2022]
|
7
|
|
8
|
Pain in Parkinson's disease associated with COMT gene polymorphisms. Behav Neurol 2014; 2014:304203. [PMID: 24825955 PMCID: PMC4006622 DOI: 10.1155/2014/304203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/07/2014] [Indexed: 01/20/2023] Open
Abstract
Background. PD patients present high incidence of pain with unknown pathogenesis. Objective. We investigated the relation of COMT polymorphisms rs4633 and rs6267 with PD pain. Subjects and Methods. One hundred PD patients and 105 controls were evaluated with simplified Mc GILL pain scale and VAS scale. PD patients were assessed with H&Y grade, UPDRS score, and HAMD scale. Polymorphisms rs4633 and rs6267 were detected by PCR and direct sequencing. Results. Fifty-seven percent of PD patients experienced pain, consisting of PD-related pain (64.91%) (the majority was dystonia pain) and non-PD-related pain (35.09%) (psychogenic pain was most frequent). The frequency of rs6267 genotype “GT/TT” and allele “T” was higher in PD pain. No difference was observed in frequencies of rs4633 between PD pain and without pain. UPDRS and depression score were higher in PD pain. The onset age was earlier in PD-related pain (57.43 ± 19.71) than non-PD-related pain (63.36 ± 6.88). Conclusion. PD patients possess a high prevalence of pain. Dystonia pain was the most frequent type of PD-related pain. COMT gene rs6267 allele “T” associated with PD pain. PD pain was influenced by disease severity and depression. PD onsets earlier in patients with PD-related pain than non-PD-related pain.
Collapse
|
9
|
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]
|
10
|
Impaired pain processing in Parkinson's disease and its relative association with the sense of smell. Parkinsonism Relat Disord 2013; 19:43-6. [DOI: 10.1016/j.parkreldis.2012.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 11/23/2022]
|
11
|
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]
|
12
|
de Andrade DC, Lefaucheur JP, Galhardoni R, Ferreira KSL, Paiva ARB, Bor-Seng-Shu E, Alvarenga L, Myczkowski ML, Marcolin MA, de Siqueira SRDT, Fonoff E, Barbosa ER, Teixeira MJ. Subthalamic deep brain stimulation modulates small fiber-dependent sensory thresholds in Parkinson's disease. Pain 2012; 153:1107-1113. [PMID: 22456108 DOI: 10.1016/j.pain.2012.02.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 01/16/2012] [Accepted: 02/14/2012] [Indexed: 11/25/2022]
Abstract
The effects of deep brain stimulation of the subthalamic nucleus on nonmotor symptoms of Parkinson's disease (PD) rarely have been investigated. Among these, sensory disturbances, including chronic pain (CP), are frequent in these patients. The aim of this study was to evaluate the changes induced by deep brain stimulation in the perception of sensory stimuli, either noxious or innocuous, mediated by small or large nerve fibers. Sensory detection and pain thresholds were assessed in 25 PD patients all in the off-medication condition with the stimulator turned on or off (on- and off-stimulation conditions, respectively). The relationship between the changes induced by surgery on quantitative sensory testing, spontaneous CP, and motor abilities were studied. Quantitative sensory test results obtained in PD patients were compared with those of age-matched healthy subjects. Chronic pain was present in 72% of patients before vs 36% after surgery (P=.019). Compared with healthy subjects, PD patients had an increased sensitivity to innocuous thermal stimuli and mechanical pain, but a reduced sensitivity to innocuous mechanical stimuli. In addition, they had an increased pain rating when painful thermal stimuli were applied, particularly in the off-stimulation condition. In the on-stimulation condition, there was an increased sensitivity to innocuous thermal stimuli but a reduced sensitivity to mechanical or thermal pain. Pain provoked by thermal stimuli was reduced when the stimulator was turned on. Motor improvement positively correlated with changes in warm detection and heat pain thresholds. Subthalamic nucleus deep brain stimulation contributes to relieve pain associated with PD and specifically modulates small fiber-mediated sensations.
Collapse
Affiliation(s)
- Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil Neurology Division, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France Transcranial Magnetic Stimulation Laboratories, Psychiatry Institute, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Nonmotor disorders and their correlation with dopamine: can they be treated by currently available methods? Neurologist 2012; 17:S9-17. [PMID: 22045328 DOI: 10.1097/nrl.0b013e318239669f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many of the nonmotor symptoms in Parkinson disease have a dopaminergic basis, whether the result of dopaminergic degeneration or as a result of dopaminergic treatment. In the latter case, the symptoms may be genuine side effects of drugs (hypotension, pathologic gambling, etc.) or they may be secondary either to the pathoplastic effect they have on the natural course of the disease (nonmotor fluctuations) or to the lack of dopamine (apathy, depression, dopamine withdrawal syndrome, etc.). In all these cases, dopaminergic treatment can be helpful. However, many other nonmotor (and motor) symptoms will have no correlation with dopamine; therefore, they require different treatments, very often with little efficacy, as in apathy or cognitive decline.
Collapse
|