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Storch A, Bremer A, Gandor F, Odin P, Ebersbach G, Löhle M. Pain Fluctuations in Parkinson's Disease and Their Association with Motor and Non-Motor Fluctuations. JOURNAL OF PARKINSON'S DISEASE 2024:JPD240026. [PMID: 39302380 DOI: 10.3233/jpd-240026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Background Pain fluctuations are a characteristic phenomenon in advanced Parkinson's disease (PD), but their temporal association with motor and non-motor symptom (NMS) fluctuations remains largely enigmatic. Moreover, data on their importance for disease severity perception and health-related quality-of-life (hr-QoL) is limited. Objective To dissect pain fluctuations with respect to pain type and frequency patterns, and their association with motor and non-motor fluctuations. Methods Prospective observational cohort study in advanced PD assessing symptom fluctuations by simultaneous hourly ratings using the PD Home diary (Off, On, Dyskinetic state), a pain diary (assessing 9 pain types) and a non-motor diary (10 key NMS) based on validated instruments. Results Forty-seven out of 55 eligible participants with fluctuating PD (51% men, median age 65, median disease duration 10 years) had sufficient datasets (>95% of hours) from 2 consecutive days. Pain was reported in 35% of waking hours with clear circadian rhythm peaking in early morning Off periods and clustering during motor Off state (49% of Off state hours with pain). Main NMS co-fluctuating with pain were "Fatigue" and "Inner Restlessness". Simultaneous assessment of global disease severity by participants revealed that pain was associated with worse disease severity only in motor On and Dyskinetic state but not in Off state, which translated into significant correlations of daily pain times with hr-QoL only during motor On and Dyskinetic state. Conclusions Aside from treating motor Off periods, specific recognition of pain particularly during motor On and Dyskinetic state comprises an important aspect for disease management in advanced PD.
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Affiliation(s)
- Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany
| | - Alexander Bremer
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Florin Gandor
- Movement Disorder Clinic, Beelitz-Heilstätten, Beelitz, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation Medicine, Memory and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Georg Ebersbach
- Movement Disorder Clinic, Beelitz-Heilstätten, Beelitz, Germany
| | - Matthias Löhle
- Department of Neurology, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany
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Barboza VR, Kubota GT, da Silva VA, Barbosa LM, Arnaut D, Rodrigues ALDL, Galhardoni R, Barbosa ER, Brunoni AR, Teixeira MJ, Cury RG, de Andrade DC. Posterior insula repetitive transcranial magnetic stimulation for chronic pain in patients with Parkinson disease - pain type matters: A double-blinded randomized sham-controlled trial. Neurophysiol Clin 2024; 54:102994. [PMID: 39024845 DOI: 10.1016/j.neucli.2024.102994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES Altered somatosensory processing in the posterior insula may play a role in chronic pain development and contribute to Parkinson disease (PD)-related pain. Posterior-superior insula (PSI) repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to have analgesic effects among patients with some chronic pain conditions. This study aimed at assessing the efficacy of PSI-rTMS for treating PD-related pain. METHODS This was a double-blinded, randomized, sham-controlled, parallel-arm trial (NCT03504748). People with PD (PwP)-related chronic pain underwent five daily PSI-rTMS sessions for a week, followed by once weekly maintenance stimulations for seven weeks. rTMS was delivered at 10 Hz and 80% of the resting motor threshold. The primary outcome was a ≥ 30% pain intensity reduction at 8 weeks compared to baseline. Functionality, mood, cognitive, motor status, and somatosensory thresholds were also assessed. RESULTS Twenty-five patients were enrolled. Mean age was 55.2 ± 9.5 years-old, and 56% were female. Nociceptive pain accounted for 60%, and neuropathic and nociplastic for 20% each. No significant difference was found for 30% pain reduction response rates between active (42.7%) and sham groups (14.6%, p = 0.26). Secondary clinical outcomes and sensory thresholds also did not differ significantly. In a post hoc analysis, PwP with nociceptive pain sub-type experienced more pain relief after active (85.7%) compared to sham PSI-rTMS (25%, p = 0.032). CONCLUSION Our preliminary results suggest that different types of PD-related pain may respond differently to treatment, and therefore people with PD may benefit from having PD-related pain well characterized in research trials and in clinical practice.
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Affiliation(s)
| | | | | | | | - Debora Arnaut
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | - Ricardo Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Group, Department of Neurology, University of São Paulo., Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Andre Russowsky Brunoni
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-903, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Movement Disorders Group, Department of Neurology, University of São Paulo., Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Group, Department of Neurology, University of São Paulo., Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira Cesar, Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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Campese N, Göbel G, Wanschitz J, Schlager A, Caliò B, Leys F, Bower P, Kellerman L, Zamarian L, Bannister K, Chaudhuri KR, Schrag A, Freeman R, Kaufmann H, Granata R, Kiechl S, Poewe W, Seppi K, Wenning G, Fanciulli A. Pain in Multiple System Atrophy: A Community-Based Survey. Mov Disord 2024. [PMID: 39101334 DOI: 10.1002/mds.29961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Pain is a frequent yet poorly characterized symptom of multiple system atrophy (MSA). Understanding the factors influencing pain and its burden is crucial for improving the symptomatic treatment and quality of life of MSA individuals. OBJECTIVE This study aimed at assessing the prevalence, characteristics, and current treatment strategies for pain in MSA. METHODS A community-based, online survey was conducted from February to May 2023. Invitations were extended to MSA individuals and informal MSA caregivers through patient advocacies and social media. RESULTS We included 190 persons with MSA and 114 caregivers. Eighty-seven percent of MSA individuals reported pain, which was more prevalent among women (odds ratio [OR]: 6.38 [95% confidence interval, CI: 1.27-32.08], P = 0.025) and low-income groups (OR: 5.02 [95% CI: 1.32-19.08], P = 0.018). Neck and shoulders (58%), back (45%), and legs (45%) were mostly affected. In the neck and shoulders, pain was associated with MSA core features, like orthostatic intolerance (OR: 4.80 [95% CI: 1.92-12.02], P = 0.001) and antecollis (OR: 3.24 [95% CI: 1.54-6.82], P = 0.002). Seventy-six percent of individuals experiencing pain received treatment, mostly nonsteroidal anti-inflammatory drugs (47%), acetaminophen (39%), and opioids (28%). Only 53% of respondents reported at least partial satisfaction with their current pain management. Pain mostly impacted work, household activities, and hobbies of MSA individuals, and caregivers' social activities. CONCLUSIONS Pain is more prevalent than previously reported in MSA and particularly affects women and low-income groups. Despite its frequency, pain management remains suboptimal, highlighting an urgent therapeutic need, likely entailing an optimized management of MSA core motor and non-motor features. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nicole Campese
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Göbel
- Institute for Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Schlager
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Bianca Caliò
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Pam Bower
- Mission MSA (formerly The Multiple System Atrophy Coalition) Inc, McLean, Virginia, USA
| | - Larry Kellerman
- Mission MSA (formerly The Multiple System Atrophy Coalition) Inc, McLean, Virginia, USA
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Kallol Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Parkinson Foundation International Centre of Excellence, Kings College Hospital, London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University Grossman School of Medicine, New York, New York, USA
| | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Stoyanova-Piroth G, Milanov I, Stambolieva K. Association between pain threshold and manifested pain assessed using a PD-specific pain scale in Parkinson's disease. Front Neurol 2024; 15:1420696. [PMID: 39131046 PMCID: PMC11312374 DOI: 10.3389/fneur.2024.1420696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/28/2024] [Indexed: 08/13/2024] Open
Abstract
Background The neurodegenerative process in Parkinson's disease (PD) affects both dopaminergic and non-dopaminergic structures, which determine the wide range of motor and non-motor symptoms (NMS), including different types of pain. Diverse mechanisms contribute to pain in PD. Abnormal nociceptive processing is considered a distinctive feature of the disease. Objective In the present study, we used a validated PD-specific pain assessment tool to investigate self-reported pain in PD patients and to analyze the association with the objective pain threshold. Methods The RIII component of the nociceptive flexor reflex was assessed in 35 patients with PD and was compared to 40 healthy controls. Self-reported pain was measured using the Bulgarian version of the King's Parkinson's Disease Pain Scale (KPPS-BG). A correlation analysis was used to investigate the relationship between the objective nociceptive threshold and PD pain as assessed by KPPS-BG. Results PD patients had a significantly lower RIII threshold than control individuals (the mean SD value was 6.24 ± 1.39 vs. 10.33 ± 1.64) when assessed in the "off" state. A statistically significant (p < 0.05) fairly negative Spearman's correlation was observed between the decreased spinal nociceptive threshold and fluctuation-related pain (-0.31). Domain 4, "nocturnal pain" (-0.21), and the KPPS-BG total score (-0.21) showed a weak negative correlation. An insignificant positive correlation was found between domain 6-"discoloration, edema/swelling"-and the RIII threshold. A higher Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score and modified Hoehn and Yahr (H&Y) scale are associated with a decreased nociceptive flexor reflex threshold. Conclusion The results of the present study demonstrate the important role of increased spinal nociception in the occurrence of pain, which is associated with fluctuations and, to a lesser extent, nocturnal pain.
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Affiliation(s)
- Galina Stoyanova-Piroth
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
- ZURZACH Care, Neurorehabilitation, Rehaklinik Baden Dättwil, Baden, Switzerland
| | - Ivan Milanov
- St. Naum Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
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Salabasidou E, Binder T, Volkmann J, Kuzkina A, Üçeyler N. Pain in Parkinson disease: a deep phenotyping study. Pain 2024; 165:1642-1654. [PMID: 38314763 DOI: 10.1097/j.pain.0000000000003173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
ABSTRACT In our prospective cross-sectional study, we comprehensively characterized Parkinson disease (PD)-related pain in monocentrically recruited patients with PD using standardized tools of pain assessment and categorization. One hundred fifty patients were systematically interviewed and filled in questionnaires for pain, depression, motor, and nonmotor symptoms. Patients with PD-related pain (PD pain), patients without PD-related pain (no PD pain), and patients without pain (no pain) were compared. Pain was present in 108/150 (72%) patients with PD, and 90/150 (60%) patients were classified as having PD-related pain. Most of the patients with PD (67/90, 74%) reported nociceptive pain, which was episodic (64/90, 71%), primarily nocturnal (56/90, 62%), and manifested as cramps (32/90, 36%). Parkinson disease-related pain was most frequently located in the feet (51/90, 57%), mainly at the toe joints (22/51, 43%). 38/90 (42%) patients with PD-related pain received analgesic medication with nonsteroidal anti-inflammatory drugs being the most frequently used (31/42, 82%) and opioids most effective (70% pain reduction of individual maximum pain intensities, range 22%-100%, confidence interval 50%-90%). All patients received oral PD treatment; however, levodopa equivalent dose showed no correlation with mean pain intensities (Spearman ρ = 0.027, P > 0.05). Our data provide a comprehensive analysis of PD-related pain, giving evidence for mainly non-neuropathic podalgia, which bears the potential to rethink assessment and analgesic treatment of pain in PD in clinical practice.
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Affiliation(s)
- Elena Salabasidou
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany. Kuzkina is now with the Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Zhang X, Shen ZL, Ji YW, Yin C, Xiao C, Zhou C. Activation and polarization of striatal microglia and astrocytes are involved in bradykinesia and allodynia in early-stage parkinsonian mice. FUNDAMENTAL RESEARCH 2024; 4:806-819. [PMID: 39156564 PMCID: PMC11330119 DOI: 10.1016/j.fmre.2023.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 08/20/2024] Open
Abstract
In addition to the cardinal motor symptoms, pain is a major non-motor symptom of Parkinson's disease (PD). Neuroinflammation in the substantia nigra pars compacta and dorsal striatum is involved in neurodegeneration in PD. But the polarization of microglia and astrocytes in the dorsal striatum and their contribution to motor deficits and hyperalgesia in PD have not been characterized. In the present study, we observed that hemiparkinsonian mice established by unilateral 6-OHDA injection in the medial forebrain bundle exhibited motor deficits and mechanical allodynia. In these mice, both microglia and astrocytes in the dorsal striatum were activated and polarized to M1/M2 microglia and A1/A2 astrocytes as genes specific to these cells were upregulated. These effects peaked 7 days after 6-OHDA injection. Meanwhile, striatal astrocytes in parkinsonian mice also displayed hyperpolarized membrane potentials, enhanced voltage-gated potassium currents, and dysfunction in inwardly rectifying potassium channels and glutamate transporters. Systemic administration of minocycline, a microglia inhibitor, attenuated the expression of genes specific to M1 microglia and A1 astrocytes in the dorsal striatum (but not those specific to M2 microglia and A2 astrocytes), attenuated the damage in the nigrostriatal dopaminergic system, and alleviated the motor deficits and mechanical allodynia in parkinsonian mice. By contrast, local administration of minocycline into the dorsal striatum of parkinsonian mice mitigated only hyperalgesia. This study suggests that M1 microglia and A1 astrocytes in the dorsal striatum may play important roles in the development of pathophysiology underlying hyperalgesia in the early stages of PD.
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Affiliation(s)
- Xue Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
| | - Zi-Lin Shen
- Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
| | - Ya-Wei Ji
- Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
| | - Cui Yin
- Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
| | - Cheng Xiao
- Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
| | - Chunyi Zhou
- Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
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Nardelli D, Gambioli F, De Bartolo MI, Mancinelli R, Biagioni F, Carotti S, Falato E, Leodori G, Puglisi-Allegra S, Vivacqua G, Fornai F. Pain in Parkinson's disease: a neuroanatomy-based approach. Brain Commun 2024; 6:fcae210. [PMID: 39130512 PMCID: PMC11311710 DOI: 10.1093/braincomms/fcae210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 04/23/2024] [Accepted: 06/17/2024] [Indexed: 08/13/2024] Open
Abstract
Parkinson's disease is a progressive neurodegenerative disorder characterized by the deposition of misfolded alpha-synuclein in different regions of the central and peripheral nervous system. Motor impairment represents the signature clinical expression of Parkinson's disease. Nevertheless, non-motor symptoms are invariably present at different stages of the disease and constitute an important therapeutic challenge with a high impact for the patients' quality of life. Among non-motor symptoms, pain is frequently experienced by patients, being present in a range of 24-85% of Parkinson's disease population. Moreover, in more than 5% of patients, pain represents the first clinical manifestation, preceding by decades the exordium of motor symptoms. Pain implies a complex biopsychosocial experience with a downstream complex anatomical network involved in pain perception, modulation, and processing. Interestingly, all the anatomical areas involved in pain network can be affected by a-synuclein pathology, suggesting that pathophysiology of pain in Parkinson's disease encompasses a 'pain spectrum', involving different anatomical and neurochemical substrates. Here the various anatomical sites recruited in pain perception, modulation and processing are discussed, highlighting the consequences of their possible degeneration in course of Parkinson's disease. Starting from peripheral small fibres neuropathy and pathological alterations at the level of the posterior laminae of the spinal cord, we then describe the multifaceted role of noradrenaline and dopamine loss in driving dysregulated pain perception. Finally, we focus on the possible role of the intertwined circuits between amygdala, nucleus accumbens and habenula in determining the psycho-emotional, autonomic and cognitive experience of pain in Parkinson's disease. This narrative review provides the first anatomically driven comprehension of pain in Parkinson's disease, aiming at fostering new insights for personalized clinical diagnosis and therapeutic interventions.
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Affiliation(s)
- Domiziana Nardelli
- Laboratory of Microscopic and Ultrastructural Anatomy, Campus Biomedico University of Roma, Rome 00128, Italy
| | - Francesco Gambioli
- Laboratory of Microscopic and Ultrastructural Anatomy, Campus Biomedico University of Roma, Rome 00128, Italy
| | | | - Romina Mancinelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Roma, Rome 00161, Italy
| | | | - Simone Carotti
- Laboratory of Microscopic and Ultrastructural Anatomy, Campus Biomedico University of Roma, Rome 00128, Italy
| | - Emma Falato
- Laboratory of Microscopic and Ultrastructural Anatomy, Campus Biomedico University of Roma, Rome 00128, Italy
| | - Giorgio Leodori
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neuroscience, Sapienza University of Roma, Rome 00185, Italy
| | | | - Giorgio Vivacqua
- Laboratory of Microscopic and Ultrastructural Anatomy, Campus Biomedico University of Roma, Rome 00128, Italy
| | - Francesco Fornai
- IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Experimental Morphology and Applied Biology, University of Pisa, Pisa 56122, Italy
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Sharon N, Yarmolinsky L, Khalfin B, Fleisher-Berkovich S, Ben-Shabat S. Cannabinoids' Role in Modulating Central and Peripheral Immunity in Neurodegenerative Diseases. Int J Mol Sci 2024; 25:6402. [PMID: 38928109 PMCID: PMC11204381 DOI: 10.3390/ijms25126402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Cannabinoids (the endocannabinoids, the synthetic cannabinoids, and the phytocannabinoids) are well known for their various pharmacological properties, including neuroprotective and anti-inflammatory features, which are fundamentally important for the treatment of neurodegenerative diseases. The aging of the global population is causing an increase in these diseases that require the development of effective drugs to be even more urgent. Taking into account the unavailability of effective drugs for neurodegenerative diseases, it seems appropriate to consider the role of cannabinoids in the treatment of these diseases. To our knowledge, few reviews are devoted to cannabinoids' impact on modulating central and peripheral immunity in neurodegenerative diseases. The objective of this review is to provide the best possible information about the cannabinoid receptors and immuno-modulation features, peripheral immune modulation by cannabinoids, cannabinoid-based therapies for the treatment of neurological disorders, and the future development prospects of making cannabinoids versatile tools in the pursuit of effective drugs.
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Affiliation(s)
| | | | | | | | - Shimon Ben-Shabat
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel; (N.S.); (L.Y.); (B.K.); (S.F.-B.)
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Lei J, Tang LL, You HJ. Pathological pain: Non-motor manifestations in Parkinson disease and its treatment. Neurosci Biobehav Rev 2024; 161:105646. [PMID: 38569983 DOI: 10.1016/j.neubiorev.2024.105646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
In addition to motor symptoms, non-motor manifestations of Parkinson's disease (PD), i.e. pain, depression, sleep disturbance, and autonomic disorders, have received increasing attention. As one of the non-motor symptoms, pain has a high prevalence and is considered an early pre-motor symptom in the development of PD. In relation to pathological pain and its management in PD, particularly in the early stages, it is hypothesized that the loss of dopaminergic neurons causes a functional deficit in supraspinal structures, leading to an imbalance in endogenous descending modulation. Deficits in dopaminergic-dependent pathways also affect non-dopaminergic neurotransmitter systems that contribute to the pathological processing of nociceptive input, the integration, and modulation of pain in PD. This review examines the onset and progression of pain in PD, with a particular focus on alterations in the central modulation of nociception. The discussion highlights the importance of abnormal endogenous descending facilitation and inhibition in PD pain, which may provide potential clues to a better understanding of the nature of pathological pain and its effective clinical management.
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Affiliation(s)
- Jing Lei
- Center for Translational Medicine Research on Sensory-Motor Diseases, Yan'an University, Yan'an 716000, China; Key Laboratory of Yan'an Sports Rehabilitation Medicine, Yan'an 716000, China
| | - Lin-Lin Tang
- Center for Translational Medicine Research on Sensory-Motor Diseases, Yan'an University, Yan'an 716000, China
| | - Hao-Jun You
- Center for Translational Medicine Research on Sensory-Motor Diseases, Yan'an University, Yan'an 716000, China; Key Laboratory of Yan'an Sports Rehabilitation Medicine, Yan'an 716000, China.
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Nogueira ACR, Pereira KC, Rodrigues VF, Alves DDPA, Marques JB, Monteiro ER, Jesus IRTD. Pain characterization in patients with Parkinson's disease. Pain Pract 2024; 24:786-797. [PMID: 38294086 DOI: 10.1111/papr.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) often report chronic pain, which is one of the most complex non-motor symptoms. Therefore, this study aims to review the literature on the characteristics of pain in patients with PD. METHODS A systematic literature review was conducted following MOOSE recommendations. Observational studies reporting pain in patients with PD were included. No time restrictions were applied, but studies in Portuguese, Spanish, and English were considered. The search was performed in PubMed®, LILACS, and SciELO databases. RESULTS Twenty-six articles of observational studies were identified, reporting an average pain prevalence of 67.36%, emphasizing the significance of this symptom in the PD population. Pain was reported in various body regions, including lower limbs, upper limbs, lumbar spine, cervical spine, and other joints. Pain classification varied, encompassing musculoskeletal pain, PD-related pain, neuropathic pain, and dystonic pain, among others. DISCUSSION Pain in patients with PD is a prevalent and multifactorial condition, significantly impacting patients' quality of life. CONCLUSION Heterogeneity in data across included studies was observed, highlighting the need for additional research to elucidate the underlying mechanisms of pain in patients with PD and develop effective therapeutic strategies to address this symptom and improve the quality of life for individuals living with the disease.
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Affiliation(s)
| | | | | | | | | | - Estêvão Rios Monteiro
- Centro Universitário Augusto Motta, Rio de Janeiro, Brazil
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- IBMR University Center, Rio de Janeiro, Brazil
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Nguy V, Brady B, Hassett LM, Canning CG, Elliott JM, Allen NE. A Mixed Methods Approach to Explore the Experience of Pain and Its Management in People with Parkinson's Disease. PARKINSON'S DISEASE 2024; 2024:8515400. [PMID: 38828214 PMCID: PMC11144069 DOI: 10.1155/2024/8515400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 06/05/2024]
Abstract
Introduction Pain in Parkinson's disease (PD) is common but poorly understood, with most research to date taking a mechanistic approach. This mixed methods study takes a broader biopsychosocial approach to assess and describe contributors of pain and explore pain management and the relationship between pain and physical activity in people with PD (PwPD) and chronic pain. Methods A structured survey evaluated respondents' contributors of pain using standardized, self-report assessments of the following: pain, peripheral neuropathy, central nociplastic change, emotional dysregulation or pathology, and maladaptive cognitions. Semistructured individual interviews were conducted with purposively sampled survey participants and analyzed using inductive thematic analysis. Results Eighty-nine PwPD (mean age 67 years, 55% female) completed the survey. The most common pain contributors were maladaptive cognitions (62%), central nociplastic change (49%), and emotional dysregulation (44%). Approaches to pain management and the response to physical activity were variable within and across individuals with different pain contributors. Four themes emerged from interviews with 24 participants: (1) causative perceptions of pain are diverse; (2) sense of control influences disease acceptance and exercise self-efficacy; (3) belief in the value of therapy; and (4) pain as the unspoken PD symptom. Physical activity was used by PwPD for pain management; however, the relationship between pain and physical activity varied based on sense of control. Conclusions Clinicians should screen for pain and assess its contributors to provide individualized, multidimensional pain management that considers the biological, psychological, and social factors of pain in PwPD. It is plausible that such an approach would promote a better sense of control for PwPD.
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Affiliation(s)
- Vanessa Nguy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
| | - Bernadette Brady
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
- South West Sydney Local Health District, Sydney, Australia
| | - Leanne M. Hassett
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
- Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Camperdown, Australia
| | - Colleen G. Canning
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
| | - James M. Elliott
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
- The Kolling Institute, Northern Sydney (Arabanoo) Precinct, St Leonards, Australia
| | - Natalie E. Allen
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
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12
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Zhang S, Zhang J, Yang Y, Zang W, Cao J. Activation of Pedunculopontine Tegmental Nucleus Alleviates the Pain Induced by the Lesion of Midbrain Dopaminergic Neurons. Int J Mol Sci 2024; 25:5636. [PMID: 38891832 PMCID: PMC11171649 DOI: 10.3390/ijms25115636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The loss of midbrain dopaminergic (DA) neurons is the fundamental pathological feature of Parkinson's disease (PD). PD causes chronic pain in two-thirds of patients. Recent studies showed that the activation of the pedunculopontine tegmental nucleus (PPTg) can effectively relieve inflammatory pain and neuropathic pain. The PPTg is located in the pontomesencephalic tegmentum, a target of deep brain stimulation (DBS) treatment in PD, and is involved in motor control and sensory integration. To test whether the lesion of midbrain DA neurons induced pain hypersensitivity, and whether the chemogenetic activation of the PPTg could modulate the pain, the AAV-hM3Dq receptor was transfected and expressed into the PPTg neurons of 6-hydroxydopamine-lesioned mice. In this study, von Frey, open field, and adhesive tape removal tests were used to assess animals' pain sensitivity, locomotor activity, and sensorimotor function and somatosensory perception, respectively. Here, we found that the lesion of midbrain DA neurons induced a minor deficit in voluntary movement but did not affect sensorimotor function and somatosensory perception in the tape removal test. The results showed that lesion led to pain hypersensitivity, which could be alleviated both by levodopa and by the chemogenetic activation of the PPTg. Activating the PPTg may be a potential therapeutic strategy to relieve pain phenotypes in PD.
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Affiliation(s)
- Shiqiang Zhang
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, China; (S.Z.); (J.Z.); (Y.Y.)
- Neuroscience Research Institute, Zhengzhou University, Zhengzhou 450001, China
| | - Jingjing Zhang
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, China; (S.Z.); (J.Z.); (Y.Y.)
- Neuroscience Research Institute, Zhengzhou University, Zhengzhou 450001, China
| | - Yihao Yang
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, China; (S.Z.); (J.Z.); (Y.Y.)
- Neuroscience Research Institute, Zhengzhou University, Zhengzhou 450001, China
| | - Weidong Zang
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, China; (S.Z.); (J.Z.); (Y.Y.)
- Neuroscience Research Institute, Zhengzhou University, Zhengzhou 450001, China
| | - Jing Cao
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, China; (S.Z.); (J.Z.); (Y.Y.)
- Neuroscience Research Institute, Zhengzhou University, Zhengzhou 450001, China
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13
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Mancini M, Calculli A, Di Martino D, Pisani A. Interplay between endocannabinoids and dopamine in the basal ganglia: implications for pain in Parkinson's disease. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:33. [PMID: 38745258 PMCID: PMC11094869 DOI: 10.1186/s44158-024-00169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
Pain is a complex phenomenon, and basal ganglia circuitry integrates many aspects of pain including motor, emotional, autonomic, and cognitive responses. Perturbations in dopamine (DA) signaling are implicated in the pathogenesis of chronic pain due to its involvement in both pain perception and relief. Several lines of evidence support the role of endocannabinoids (eCBs) in the regulation of many electrical and chemical aspects of DAergic neuron function including excitability, synaptic transmission, integration, and plasticity. However, eCBs play an even more intricate and intimate relationship with DA, as indicated by the adaptive changes in the eCB system following DA depletion. Although the precise mechanisms underlying DA control on pain are not fully understood, given the high correlation of eCB and DAergic system, it is conceivable that eCBs may be part of these mechanisms.In this brief survey, we describe the reciprocal regulation of eCB-DA neurotransmission with a particular emphasis on the actions of eCBs on ionic and synaptic signaling in DAergic neurons mediated by CB receptors or independent on them. Furthermore, we analyze the eCB-DA imbalance which characterizes pain condition and report the implications of reduced DA levels for pain in Parkinson's disease. Lastly, we discuss the potential of the eCB-DA system in the development of future therapeutic strategies for the treatment of pain.
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Affiliation(s)
- Maria Mancini
- Department of Brain and Behavioral Sciences, University of Pavia, c/o Mondino Foundation Via Mondino, 2, Pavia, 27100, Italy
| | - Alessandra Calculli
- Department of Brain and Behavioral Sciences, University of Pavia, c/o Mondino Foundation Via Mondino, 2, Pavia, 27100, Italy
- IRCCS Mondino Foundation, Pavia, 27100, Italy
| | - Deborah Di Martino
- Department of Brain and Behavioral Sciences, University of Pavia, c/o Mondino Foundation Via Mondino, 2, Pavia, 27100, Italy
- IRCCS Mondino Foundation, Pavia, 27100, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, c/o Mondino Foundation Via Mondino, 2, Pavia, 27100, Italy.
- IRCCS Mondino Foundation, Pavia, 27100, Italy.
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14
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Kurihara K, Fujioka S, Mizutani Y, Watanabe H, Iwaoka K, Maeda T, Seki M, Tezuka T, Nakahara J, Konno T, Ishiguro T, Onodera O, Asano Y, Takahashi K, Rizos A, Chaudhuri KR, Tsuboi Y. Validation study of the Japanese version of the King's Parkinson's Disease Pain Scale and the King's Parkinson's Disease Pain Questionnaire. Parkinsonism Relat Disord 2024; 120:106012. [PMID: 38290410 DOI: 10.1016/j.parkreldis.2024.106012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION The King's Parkinson's Disease Pain Scale (KPPS)/King's Parkinson's Disease Pain Questionnaire (KPPQ) was developed as a tool to quantitatively assess pain in patients with Parkinson's disease (PwPD). Here, we conducted a Japanese multicenter validation study to verify the reliability of KPPS/KPPQ in Japanese PwPD. METHODS PwPD, ≥20 years, with unexplained pain were included; those with a definitive primary cause of pain other than PD were excluded. A total of 151 patients who fulfilled the criteria were analyzed, and test-retest reliability was investigated in 25 individuals. RESULTS The 151 patients included 101 women (66.9 %); mean age 68.3 ± 9.9 years, mean disease duration 9.2 ± 5.2 years. The most frequent pain type in the KPPS classification was musculoskeletal pain (82.8 %). There was a positive correlation between KPPS total score and the Non-Motor Symptoms Scale (NMSS) total score, NMSS item 27, the Parkinson's disease sleep scale-version 2 (PDSS-2) total score, PDSS-2 item 10, the Parkinson's Disease Questionnaire-8 (PDQ-8) summary index and PDQ-8 item 7. Cronbach's alpha of KPPS was 0.626 (0.562-0.658) and the intraclass correlation coefficient of test-retest reliability was 0.740. Cronbach's alpha of KPPQ was 0.660 (0.617-0.705) and a test-retest reliability of kappa coefficient was 0.593 (0.0-1.0). CONCLUSIONS KPPS correlated well with other scales for assessing pain. KPPS correlated well with patients' quality of life, non-motor symptoms, and sleep disturbances. The reproducibility of KPPS/KPPQ makes it suitable for continuous evaluation of the same patient. On the other hand, the internal consistency of KPPS/KPPQ is rather low.
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Affiliation(s)
- Kanako Kurihara
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Yasuaki Mizutani
- Department of Neurology, Fujita Health University School of Medicine, 1-98 Dengakugakugo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University School of Medicine, 1-98 Dengakugakugo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Kazuhiro Iwaoka
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 2-1-1 Idai-dori, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Tetsuya Maeda
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 2-1-1 Idai-dori, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Morinobu Seki
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Toshiki Tezuka
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takuya Konno
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8585, Japan
| | - Takanobu Ishiguro
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8585, Japan
| | - Yuri Asano
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashi dai Fuchu-City, Tokyo, 183-0042, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashi dai Fuchu-City, Tokyo, 183-0042, Japan
| | - Alexandra Rizos
- Parkinson's Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan.
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15
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Mylius V, Moisset X, Rukavina K, Rosner J, Korwisi B, Marques A, Lloret SP, Kägi G, Bohlhalter S, Bannister K, Chaudhuri KR, Barke A, Tinazzi M, Brefel-Courbon C, Treede RD, de Andrade DC. New ICD-11 diagnostic criteria for chronic secondary musculoskeletal pain associated with Parkinson disease. Pain 2024:00006396-990000000-00497. [PMID: 38227568 DOI: 10.1097/j.pain.0000000000003138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/10/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Katarina Rukavina
- Division of Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jan Rosner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychological Interventions, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Ana Marques
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Santiago Perez Lloret
- Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Observatorio de Salud Pública, Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires, Argentina
| | - Georg Kägi
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Kirsty Bannister
- Division of Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Kallol Ray Chaudhuri
- Division of Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Antonia Barke
- Division of Clinical Psychology and Psychological Interventions, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Christine Brefel-Courbon
- Department of Clinical Pharmacology and Neurosciences, University Hospital of Toulouse, Inserm, Toulouse, France
| | - Rolf Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, and Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Heidelberg University, Mannheim, Germany
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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16
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Cansiz D, Unal I, Beler M, Ustundag UV, Ak E, Emekli-Alturfan E, Alturfan AA. The effect of acetic acid-induced pain in Parkinson's disease model in zebrafish. Neurotoxicology 2023; 99:14-23. [PMID: 37683694 DOI: 10.1016/j.neuro.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/20/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease caused by the degeneration of dopaminergic neurons and the accumulation of Lewy bodies. Pain is one of the most common non-motor symptoms in PD, but the molecular mechanism of pain in PD is not fully understood, which prevents early diagnosis of PD. We aimed to determine the changes in opioidergic pathways when external pain is inflicted by inducing pain intraperitoneally in zebrafish, for which we generated a rotenone-induced PD model. After behavioural analyses in control(C), acetic acid (AA), rotenone (ROT), and rotenone+ acetic acid (ROT+AA) groups, catecholamine levels in brain tissue were determined by LC-MS/MS, expression of opioid peptides and their receptors by RT-PCR, expression of tyrosine hydroxylase by immunohistochemical method, and analyses of oxidant-antioxidant parameters by spectrophotometric methods. In the ROT group, distance travelled, average speed, and brain dopamine levels decreased, while LPO (lipid peroxidation) and NO (nitric oxide) increased as indicators of oxidative damage, and the SOD activity decreased. The mRNA expression of lrrk, pink1, and park7 genes associated with PD increased, while the mRNA expression of park2 decreased. This indicates that rotenone exposure is a suitable means to induce PD in zebrafish. The fact that body curvature was higher in the AA group than in the ROT and ROT+AA groups, as well as the decreased expression of penka, pdyn, and ion channels associated with the perception of peripheral pain in the ROT+AA group, suggest that mechanisms associated with pain are impaired in the rotenone-induced PD model in zebrafish.
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Affiliation(s)
- Derya Cansiz
- Department of Biochemistry, Faculty of Medicine, Istanbul Medipol University, Kavacık, Istanbul, Turkey; Department of Biochemistry, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Ismail Unal
- Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Merih Beler
- Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Unsal Veli Ustundag
- Department of Biochemistry, Faculty of Medicine, Istanbul Medipol University, Kavacık, Istanbul, Turkey
| | - Esin Ak
- Department of Histology and Embryology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Ebru Emekli-Alturfan
- Department of Basic Medical Sciences, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Ahmet Ata Alturfan
- Department of Biochemistry, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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17
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Barboza VR, Kubota GT, da Silva VA, Barbosa LM, Arnaut D, Rodrigues ALDL, Galhardoni R, Cury RG, Barbosa ER, Brunoni AR, Teixeira MJ, de Andrade DC. Parkinson's Disease-related Pains are Not Equal: Clinical, Somatosensory and Cortical Excitability Findings in Individuals With Nociceptive Pain. THE JOURNAL OF PAIN 2023; 24:2186-2198. [PMID: 37442404 DOI: 10.1016/j.jpain.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
Chronic pain is a frequent and burdensome nonmotor symptom of Parkinson's disease (PD). PD-related chronic pain can be classified as nociceptive, neuropathic, or nociplastic, the former being the most frequent subtype. However, differences in neurophysiologic profiles between these pain subtypes, and their potential prognostic and therapeutic implications have not been explored yet. This is a cross-sectional study on patients with PD (PwP)-related chronic pain (ie, started with or was aggravated by PD). Subjects were assessed for clinical and pain characteristics through questionnaires and underwent quantitative sensory tests and motor corticospinal excitability (CE) evaluations. Data were then compared between individuals with nociceptive and non-nociceptive (ie, neuropathic or nociplastic) pains. Thirty-five patients were included (51.4% male, 55.7 ± 11.0 years old), 20 of which had nociceptive pain. Patients with nociceptive PD-related pain had lower warm detection threshold (WDT, 33.34 ± 1.39 vs 34.34 ± 1.72, P = .019) and mechanical detection threshold (MDT, 2.55 ± 1.54 vs 3.86 ± .97, P = .007) compared to those with non-nociceptive pains. They also presented a higher proportion of low rest motor threshold values than the non-nociceptive pain ones (64.7% vs 26.6%, P = .048). In non-nociceptive pain patients, there was a negative correlation between WDT and non-motor symptoms scores (r = -.612, P = .045) and a positive correlation between MDT and average pain intensity (r = .629, P = .038), along with neuropathic pain symptom scores (r = .604, P = .049). It is possible to conclude that PD-related chronic pain subtypes have distinctive somatosensory and CE profiles. These preliminary data may help better frame previous contradictory findings in PwP and may have implications for future trial designs aiming at developing individually-tailored therapies. PERSPECTIVE: This work showed that PwP-related nociceptive chronic pain may have distinctive somatosensory and CE profiles than those with non-nociceptive pain subtypes. These data may help shed light on previous contradictory findings in PwP and guide future trials aiming at developing individually-tailored management strategies.
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Affiliation(s)
| | | | | | | | - Debora Arnaut
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Ricardo Galhardoni
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Andre Russowsky Brunoni
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Movement Disorders Group, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Department of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg E, Denmark
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18
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de Andrade DC, Mylius V, Perez-Lloret S, Cury RG, Bannister K, Moisset X, Taricani Kubota G, Finnerup NB, Bouhassira D, Chaudhuri KR, Graven-Nielsen T, Treede RD. Pain in Parkinson disease: mechanistic substrates, main classification systems, and how to make sense out of them. Pain 2023; 164:2425-2434. [PMID: 37318012 DOI: 10.1097/j.pain.0000000000002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
ABSTRACT Parkinson disease (PD) affects up to 2% of the general population older than 65 years and is a major cause of functional loss. Chronic pain is a common nonmotor symptom that affects up to 80% of patients with (Pw) PD both in prodromal phases and during the subsequent stages of the disease, negatively affecting patient's quality of life and function. Pain in PwPD is rather heterogeneous and may occur because of different mechanisms. Targeting motor symptoms by dopamine replacement or with neuromodulatory approaches may only partially control PD-related pain. Pain in general has been classified in PwPD according to the motor signs, pain dimensions, or pain subtypes. Recently, a new classification framework focusing on chronic pain was introduced to group different types of PD pains according to mechanistic descriptors: nociceptive, neuropathic, or neither nociceptive nor neuropathic. This is also in line with the International Classification of Disease-11 , which acknowledges the possibility of chronic secondary musculoskeletal or nociceptive pain due to disease of the CNS. In this narrative review and opinion article, a group of basic and clinical scientists revise the mechanism of pain in PD and the challenges faced when classifying it as a stepping stone to discuss an integrative view of the current classification approaches and how clinical practice can be influenced by them. Knowledge gaps to be tackled by coming classification and therapeutic efforts are presented, as well as a potential framework to address them in a patient-oriented manner.
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Affiliation(s)
- Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Veit Mylius
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
- Department of Neurology, Kantonsspital, St. Gallen, Switzerland
| | - Santiago Perez-Lloret
- Observatorio de Salud Pública, Universidad Católica Argentina, Consejo de Investigaciones Científicas y Técnicas (UCA-CONICET), Buenos Aires, Argentina
- Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Gabriel Taricani Kubota
- Department of Neurology, Centre for Neurorehabilitation, Valens, Switzerland
- Pain Center, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
- Center for Pain Treatment, Institute of Cancer of the State of Sao Paulo, University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Kallol Ray Chaudhuri
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence in Care and Research, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
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19
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Di Luca DG, Gilmour GS, Fearon C, Swinkin E, Freitas E, Kuhlman G, Fox SH, Mestre T. A Phase Ib, Double Blind, Randomized Study of Cannabis Oil for Pain in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1114-1119. [PMID: 37476317 PMCID: PMC10354611 DOI: 10.1002/mdc3.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/02/2023] [Accepted: 04/07/2023] [Indexed: 07/22/2023] Open
Abstract
Background Pain is common in Parkinson's disease (PD), but effective therapies are limited. Objectives To determine the maximum tolerated dose (MTD) and safety of formulations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) for pain in PD. Methods In this phase 1b, double-blind, randomized, single-center study, participants were randomized to three formulations of THC/CBD (18:0, 10:10, and 1:20). The MTD, adverse events (AE), and tolerability are described for each formulation. Results Eight participants were randomized. The MTD was similar among groups (0.8-0.9 mL/daily), and there were no serious AE or study drop-outs. The most common AE were drowsiness and dizziness (three participants). Epworth sleepiness scale scores were higher in the high CBD formulation (1:20). Conclusions In patients with pain and PD, mixed formulations of THC/CBD were tolerated with no serious AE. Considering the safety profile, future phase II studies should be considered.
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Affiliation(s)
- Daniel G. Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders ClinicKrembil Brain Institute, Toronto Western HospitalTorontoOntarioCanada
| | - Gabriela S. Gilmour
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders ClinicKrembil Brain Institute, Toronto Western HospitalTorontoOntarioCanada
| | - Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders ClinicKrembil Brain Institute, Toronto Western HospitalTorontoOntarioCanada
| | - Emily Swinkin
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders ClinicKrembil Brain Institute, Toronto Western HospitalTorontoOntarioCanada
| | - Eliza Freitas
- Division of NeurologyMcMaster UniversityHamiltonOntarioCanada
| | - Greg Kuhlman
- Department of Neurology and Rehabilitation MedicineGardner Family Center for Parkinson's Disease and Movement Disorders, University of CincinnatiCincinnatiOhioUSA
| | - Susan H. Fox
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders ClinicKrembil Brain Institute, Toronto Western HospitalTorontoOntarioCanada
| | - Tiago Mestre
- Ottawa Hospital Research Institute; University of Ottawa Brain and Mind Research InstituteOttawaOntarioCanada
- Division of Neurology, Department of MedicineThe Ottawa HospitalOttawaOntarioCanada
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Chen Q, Scherbaum R, Gold R, Pitarokoili K, Mosig A, Zella S, Tönges L. Data-driven subtyping of Parkinson's disease: comparison of current methodologies and application to the Bochum PNS cohort. J Neural Transm (Vienna) 2023; 130:763-776. [PMID: 37000269 PMCID: PMC10199871 DOI: 10.1007/s00702-023-02627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
Considerable efforts have been made to better describe and identify Parkinson's disease (PD) subtypes. Cluster analyses have been proposed as an unbiased development approach for PD subtypes that could facilitate their identification, tracking of progression, and evaluation of therapeutic responses. A data-driven clustering analysis was applied to a PD cohort of 114 subjects enrolled at St. Josef-Hospital of the Ruhr University in Bochum (Germany). A wide spectrum of motor and non-motor scores including polyneuropathy-related measures was included into the analysis. K-means and hierarchical agglomerative clustering were performed to identify PD subtypes. Silhouette and Calinski-Harabasz Score Elbow were then employed as supporting evaluation metrics for determining the optimal number of clusters. Principal Component Analysis (PCA), analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were conducted to determine the relevance of each score for the clusters' definition. Three PD cluster subtypes were identified: early onset mild type, intermediate type, and late-onset severe type. The between-cluster analysis consistently showed highly significant differences (P < 0.01), except for one of the scores measuring polyneuropathy (Neuropathy Disability Score; P = 0.609) and Levodopa dosage (P = 0.226). Parkinson's Disease Questionnaire (PDQ-39), Non-motor Symptom Questionnaire (NMSQuest), and the MDS-UPDRS Part II were found to be crucial factors for PD subtype differentiation. The present analysis identifies a specific set of criteria for PD subtyping based on an extensive panel of clinical and paraclinical scores. This analysis provides a foundation for further development of PD subtyping, including k-means and hierarchical agglomerative clustering.Trial registration: DRKS00020752, February 7, 2020, retrospectively registered.
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Affiliation(s)
- Qiang Chen
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
| | - Raphael Scherbaum
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, 44801, Bochum, Germany
- Immune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
- Immune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Axel Mosig
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, 44801, Bochum, Germany
- Bioinformatics Group, Ruhr University Bochum, 44801, Bochum, Germany
| | - Samis Zella
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany
- Department of Psychiatry, Landschaftsverband Rheinland-Klinik (LVR-Klinik), 40764, Langenfeld, Germany
- Medizinisches Zentrum für Erwachsene mit Behinderung (MZEB), Landschaftsverband Rheinland-Klinik, 40764, Langenfeld, Germany
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, 44791, Bochum, Germany.
- Center for Protein Diagnostics (ProDi), Ruhr University Bochum, 44801, Bochum, Germany.
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Kurihara K, Fujioka S, Mishima T, Tsuboi Y. Evaluation of perception threshold and pain in patients with Parkinson's disease using PainVision ®. Front Neurol 2023; 14:1130986. [PMID: 37213902 PMCID: PMC10196013 DOI: 10.3389/fneur.2023.1130986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Pain is one of the most frequent non-motor symptoms occurring in patients with Parkinson's disease (PD). Traditionally, the Visual Analog Pain Scale (VAS), Numerical Rating Scale (NRS), and Wong-Baker Faces Pain Rating Scale (FRS) have been used for clinical pain assessment, but these assessments are subjective at best. In contrast, PainVision® is a perceptual/pain analyzer that can quantitatively evaluate pain as "pain intensity" based on "current perception threshold" and "pain equivalent current." We evaluated the current perception threshold in all PD patients and pain intensity in PD patients with pain using PainVision®. Methods We recruited 48 patients with PD (PwPD) with pain and 52 PwPD without pain. For patients with pain, we measured current perception threshold, pain equivalent current, and pain intensity using PainVision®, in addition to evaluation by VAS, NRS, and FRS. For patients without pain, only current perception threshold was measured. Results There was no correlation with either VAS or FRS, whereas only weak correlation was identified for NRS (γ = -0.376) with pain intensity. Current perception threshold was positively correlated with duration of the disease (γ = 0.347) and the Hoehn and Yahr stage (γ = 0.259). As a quantitative evaluation of pain, pain intensity by PainVision® does not correlate with conventional subjective pain assessments. Discussion This new quantitative evaluation method of pain may be suitable as an evaluation tool for future intervention research. Current perception threshold in PwPD was related to the duration and severity of the disease and may be involved in peripheral neuropathy associated with PD.
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Affiliation(s)
| | | | | | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
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22
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Al-Wardat M, Geroin C, Schirinzi T, Etoom M, Tinazzi M, Pisani A, Natoli S. Axial postural abnormalities and pain in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:77-85. [PMID: 36550202 DOI: 10.1007/s00702-022-02576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Axial postural abnormalities and pain are two main determinants of poor quality of life in patients with Parkinson's disease (PD). Indeed, a detailed characterization of pain and other non-motor symptoms in patients with PAs has not been provided yet. The aim of this study is to assess the phenomenology of pain and other non-motor symptoms in PD patients with Pisa syndrome and camptocormia compared to PD patients without axial postural abnormality. Forty-five PD participants were equally distributed in three groups: patients with Pisa syndrome (PS), patients with Camptocormia (CC), and patients without postural abnormalities (PD). Pain characteristics were assessed by Kings Parkinson's Pain Scale (KPPS), brief pain inventory (BPI), and numeric pain rating scale (NRS). All participants completed clinical assessments by non-motor symptom scale (NMSS), and movement disorder society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts II-III. Patients with and without axial postural abnormalities showed one or more types of pain, being fluctuation, nocturnal, chronic, and musculoskeletal the most frequently reported in Pisa Syndrome and camptocormia. PD group compared with PS and CC groups showed differences in the KPPS, NMSS, BPI pain severity and interference, and NRS total scores. No significant differences were found between PS group compared with CC group with exception of the NMSS total scores. PD patients with Pisa syndrome or camptocormia have a higher burden of musculoskeletal, chronic and fluctuation pain than PD patients without axial postural abnormalities, suggesting different etiologies of pain and possible different treatments.
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Affiliation(s)
- Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mohammad Etoom
- Physical Therapy Division, Allied Medical Sciences Department, Aqaba University of Technology, Aqaba, Jordan
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Maugeri Pavia, Pavia, Italy
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23
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Pilipovich AA, Vorob'eva OV. [Motor and autonomic disorders influence on pain syndrome of patients with Parkinson's disease of the I-III H&Y stages]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:59-67. [PMID: 37084366 DOI: 10.17116/jnevro202312304159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To evaluate the influence of motor and autonomic disorders on the pain of patients with PD of the I-III H&Y stages and possibility of correcting the pain with dopamine receptor agonists (ADR). MATERIAL AND METHODS 252 patients (128 women and 124 men, 42-80 years old) with PD of I-III Hoehn and Yahr stages (H&Y) were examined using the following scales: UPDRS, daily activity Sch&En, quality of life PDQ-39, MMSE, BDI, PFS-16, NMSQuest, GSRS, AUA; 53 patients were piribedil treated during 6 months. RESULTS Our results indicated a wide prevalence of pain syndrome in PD patients (58.6%), starting from the early stages (50% for the Ist stage). The most stable pain associations were found with the PD stage, levodopa doses, severity of motor symptoms (postural disorders and hypokinesia manifestations) and motor complications («off-periods» and dyskinesias), as well as non-motor PD manifestations depression and autonomic dysfunctions (constipation, swallowing disorders, and frequent urination). The regression analysis showed, that the severity of motor complications and depression were the predictors of pain occurrence. The pain syndrome in patients with PD of I-III stages underwent significant regression (by 51% and 62%, after 1.5 and 6 months of therapy, respectively) after ADR (piribedil) addition to their therapy; it's probably due to improving the motor component and decreasing depressive disorders. CONCLUSIONS The piribedil inclusion contributes to the reduction of pain syndrome, regardless is it used in monotherapy or in conjunction with levodopa preparations.
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Affiliation(s)
- A A Pilipovich
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O V Vorob'eva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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24
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Molot J, Sears M, Marshall LM, Bray RI. Neurological susceptibility to environmental exposures: pathophysiological mechanisms in neurodegeneration and multiple chemical sensitivity. REVIEWS ON ENVIRONMENTAL HEALTH 2022; 37:509-530. [PMID: 34529912 DOI: 10.1515/reveh-2021-0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/13/2021] [Indexed: 05/23/2023]
Abstract
The World Health Organization lists air pollution as one of the top five risks for developing chronic non-communicable disease, joining tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity. This review focuses on how host defense mechanisms against adverse airborne exposures relate to the probable interacting and overlapping pathophysiological features of neurodegeneration and multiple chemical sensitivity. Significant long-term airborne exposures can contribute to oxidative stress, systemic inflammation, transient receptor subfamily vanilloid 1 (TRPV1) and subfamily ankyrin 1 (TRPA1) upregulation and sensitization, with impacts on olfactory and trigeminal nerve function, and eventual loss of brain mass. The potential for neurologic dysfunction, including decreased cognition, chronic pain and central sensitization related to airborne contaminants, can be magnified by genetic polymorphisms that result in less effective detoxification. Onset of neurodegenerative disorders is subtle, with early loss of brain mass and loss of sense of smell. Onset of MCS may be gradual following long-term low dose airborne exposures, or acute following a recognizable exposure. Upregulation of chemosensitive TRPV1 and TRPA1 polymodal receptors has been observed in patients with neurodegeneration, and chemically sensitive individuals with asthma, migraine and MCS. In people with chemical sensitivity, these receptors are also sensitized, which is defined as a reduction in the threshold and an increase in the magnitude of a response to noxious stimulation. There is likely damage to the olfactory system in neurodegeneration and trigeminal nerve hypersensitivity in MCS, with different effects on olfactory processing. The associations of low vitamin D levels and protein kinase activity seen in neurodegeneration have not been studied in MCS. Table 2 presents a summary of neurodegeneration and MCS, comparing 16 distinctive genetic, pathophysiological and clinical features associated with air pollution exposures. There is significant overlap, suggesting potential comorbidity. Canadian Health Measures Survey data indicates an overlap between neurodegeneration and MCS (p < 0.05) that suggests comorbidity, but the extent of increased susceptibility to the other condition is not established. Nevertheless, the pathways to the development of these conditions likely involve TRPV1 and TRPA1 receptors, and so it is hypothesized that manifestation of neurodegeneration and/or MCS and possibly why there is divergence may be influenced by polymorphisms of these receptors, among other factors.
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Affiliation(s)
- John Molot
- Family Medicine, University of Ottawa Faculty of Medicine, North York, ON, Canada
| | | | | | - Riina I Bray
- Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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25
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Angelopoulou E, Papadopoulos AN, Spantideas N, Bougea A. Migraine, Tension-Type Headache and Parkinson's Disease: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1684. [PMID: 36422223 PMCID: PMC9697239 DOI: 10.3390/medicina58111684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 12/01/2023]
Abstract
Background and Objectives: The relationship between migraine and tension-type headache (TTH) with Parkinson's disease (PD) is controversial, while a common pathophysiological link remains obscure. The aim of this systematic review is to investigate the association between PD, migraine and TTH. Materials and Methods: Following PRISMA, we searched MEDLINE, WebofScience, Scopus, CINAHL, Cochrane Library and ClinicalTrials.gov up to 1 July 2022 for observational studies examining the prevalence and/or associations of PD with migraine and TTH. We pooled proportions, standardized mean differences (SMD) and odds ratios (OR) with random effects models. The risk of bias was assessed with the Newcastle-Ottawa scale (PROSPERO CRD42021273238). Results: Out of 1031 screened studies, 12 were finally included in our review (median quality score 6/9). The prevalence of any headache among PD patients was estimated at 49.1% (760 PD patients; 95% CI 24.8-73.6), migraine prevalence at 17.2% (1242 PD patients; 95% CI 9.9-25.9), while 61.5% (316 PD patients; 95% CI 52.6-70.1) of PD patients with migraine reported headache improvement after PD onset. Overall, migraine was not associated with PD (302,165 individuals; ORpooled = 1.11; 95% CI 0.72-1.72).However, cohort studies demonstrated a positive association of PD among lifetime migraineurs (143,583 individuals; ORpooled = 1.54, 95% CI 1.28-1.84), while studies on 12-month migraine prevalence yielded an inverse association (5195 individuals; ORpooled = 0.64, 95% CI 0.43-0.97). Similar findings were reported by 3 studies with data on the TTH-PD relationship (high prevalence, positive association when examined prospectively and an inverse relationship on 12-month prevalence). These data were not quantitatively synthesized due to methodological differences among the studies. Finally, PD patients suffering from any headache had a lower motor unified Parkinson's disease rating scale (UPDRS) score (503 PD patients; SMD -0.39; 95% CI -0.57 to -0.21) compared to PD patients not reporting headache. There is an unclear association of headaches in genetic PD cohorts. Conclusions: Observational data suggest that migraine and TTH could be linked to PD, but the current literature is conflicting.
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Affiliation(s)
- Efthalia Angelopoulou
- Department of Neurology, Medical School, Eginition Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas Nikolaos Papadopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Spantideas
- Department of Neurology, Medical School, Eginition Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Bougea
- Department of Neurology, Medical School, Eginition Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Chiu CH, Weng SJ, Yeh SHH, Jhao YT, Chang HF, Huang WS, Cheng CY, Yeh CC, Ma KH. Assessment of the anti-nociceptive effects of fetal ventral mesencephalic tissue allografts in a rat model of hemi-Parkinson's disease using fMRI. Front Aging Neurosci 2022; 14:948848. [PMID: 36466604 PMCID: PMC9716198 DOI: 10.3389/fnagi.2022.948848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2023] Open
Abstract
Extensive studies showed increased subjective pain sensitivity in Parkinson's disease (PD), which appeared to be partially reversed by dopaminergic (DA) treatment. Although cell replacement represents an attractive therapeutic strategy, its potential for PD-related hyperalgesia remains unclear. We investigated re-establishment of DA function via allografting exogenic DA cells on pain hypersensitivity in a rat model of PD. We evaluated the anti-nociceptive effects of fetal ventral mesencephalic (rVM) tissue allografts in PD rats after unilateral 6-OHDA-induced toxicity in the medial forebrain bundle. The drug -induced rotation test was used to validate the severity of the nigrostriatal lesion; von Frey and thermal pain tests were employed to evaluate nociceptive function. Nociception-induced cerebral blood volume (CBV) response was measured using a 4.7-T MR system. Finally, the immunohistochemical (IHC) studies were performed and the results were compared with the imaging findings from functional magnetic resonance imaging (fMRI). The grafts significantly improved drug-induced rotation behavior and increased mechanical and thermal nociceptive thresholds in PD rats. The elevation of CBV signals significantly recovered on the grafted striatum, whereas this effect was inhibited by the D2R antagonist eticlopride in each striatum. Quantitative IHC analysis revealed the transplantation markedly increased the numbers of tyrosine hydroxylase immunoreactive cells. Therefore, we concluded transplantation of rVM tissue results in anti-nociceptive effects and improves motor function. Moreover, in vivo CBV response confirmed the key role of D2R-mediated pain modulation. Therefore, we demonstrate fMRI as a reliable imaging index in evaluating the anti-nociceptive therapeutic effects of fetal rVM transplantation in the rat model of PD.
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Affiliation(s)
- Chuang-Hsin Chiu
- Department of Nuclear Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Shao-Ju Weng
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | | | - Yun-Ting Jhao
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | | | - Wen-Sheng Huang
- Department of Nuclear Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Cheng-Yi Cheng
- Department of Nuclear Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chun-Chang Yeh
- Department of Anesthesiology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Kuo-Hsing Ma
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
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27
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Yu WY, Yang QH, Wang XQ. The mechanism of exercise for pain management in Parkinson's disease. Front Mol Neurosci 2022; 15:1039302. [PMID: 36438185 PMCID: PMC9684336 DOI: 10.3389/fnmol.2022.1039302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/07/2022] [Indexed: 08/03/2023] Open
Abstract
The research and clinical applications of exercise therapy to the treatment of Parkinson's disease (PD) are increasing. Pain is among the important symptoms affecting the daily motor function and quality of life of PD patients. This paper reviewed the progress of research on different exercise therapies for the management of pain caused by PD and described the role and mechanism of exercise therapy for pain relief. Aerobic exercise, strength exercise, and mind-body exercise play an effective role in pain management in PD patients. The pain suffered by PD patients is divided into central neuropathic, peripheral neuropathic, and nociceptive pain. Different types of pain may coexist with different mechanistic backgrounds and treatments. The analgesic mechanisms of exercise intervention in PD-induced pain include altered cortical excitability and synaptic plasticity, the attenuation of neuronal apoptosis, and dopaminergic and non-dopaminergic analgesic pathways, as well as the inhibition of oxidative stress. Current studies related to exercise interventions for PD-induced pain suffer from small sample sizes and inadequate research of analgesic mechanisms. The neurophysiological effects of exercise, such as neuroplasticity, attenuation of neuronal apoptosis, and dopaminergic analgesic pathway provide a sound biological mechanism for using exercise in pain management. However, large, well-designed randomized controlled trials with improved methods and reporting are needed to evaluate the long-term efficacy and cost-effectiveness of exercise therapy for PD pain.
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Affiliation(s)
- Wen-Ye Yu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Qi-Hao Yang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangtishang Orthopaedic Hospital, Shanghai, China
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28
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Proinflammatory profile in the skin of Parkinson's disease patients with and without pain. PLoS One 2022; 17:e0276564. [PMID: 36301901 PMCID: PMC9612575 DOI: 10.1371/journal.pone.0276564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background Pain is a common non-motor symptom of Parkinson`s disease (PD), however, its pathomechanism remains elusive. Objective We aimed to investigate the local gene expression of selected proinflammatory mediators in patients with PD and correlated our data with patients`pain phenotype. Methods We recruited 30 patients with PD and 30 healthy controls. Pain intensity of patients was assessed using the Numeric Rating Scale (NRS) and patients were stratified into PD pain (NRS≥4) and PD No Pain (NRS<4) subgroups. Skin punch biopsies were immunoassayed for protein-gene product 9.5 as a pan-neuronal marker and intraepidermal nerve fiber density (IEFND). Quantitative real-time polymerase chain reaction (qRT-PCR) analysis was performed to assess the gene expression of inflammatory mediators in the skin compared to controls. Results Patients with PD had lower distal IENFD compared to healthy controls. In skin samples, IL-2 (p<0.001) and TNF-α (p<0.01) were expressed higher in PD patients compared to controls. IL-1β (p<0.05) was expressed higher in the PD pain group compared to healthy controls. PD patients with pain receiving analgesics had a lower expression of TNF-α (p<0.05) in the skin compared to those not receiving treatment. Conclusions Our data suggest the occurrence of a local, peripheral inflammatory response in the skin in PD, but do not support this being a relevant factor contributing to pain in PD.
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Seki M, Kurihara K, Konno T, Fujioka S, Tsuboi Y. [Characteristics and treatment of pain in Parkinson's disease]. Rinsho Shinkeigaku 2022; 62:763-772. [PMID: 36184418 DOI: 10.5692/clinicalneurol.cn-001733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Pain is a representative non-motor symptom in patients with Parkinson's disease (PD). Pain is one of the most common symptoms that plague patients with PD regardless of the stage of the disease, also it can exacerbate other symptoms, such as depression, anxiety or sleep disturbance, and lead to impaired quality of life. However, pain is often not adequately evaluated and treated. PD patients complain of a wide variety of pain, including both PD-related pain which caused by PD-specific symptoms, for example, rigidity, bradykinesia or motor fluctuation, and PD-unrelated pain, and it can be divided into central and peripheral depending on the site of the disorder. In the medical care of the pain, it is important to evaluate the type and severity of the pain using PD-specific assessment scales such as King's PD pain scale and to consider the evidence-based treatment methods according to the pathophysiology of the pain.
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Affiliation(s)
- Morinobu Seki
- Department of Neurology, Keio University School of Medicine, Japan
| | - Kanako Kurihara
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Takuya Konno
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
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Naisby J, Amjad A, Ratcliffe N, Yarnall AJ, Rochester L, Walker R, Baker K. A Survey of People With Parkinson's and Their Carers: The Management of Pain in Parkinson's. J Geriatr Psychiatry Neurol 2022; 35:613-621. [PMID: 34235999 PMCID: PMC9210119 DOI: 10.1177/08919887211023592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain in Parkinson's is problematic but under treated in clinical practice. Healthcare professionals must understand the impact of pain in Parkinson's and patient preferences for management. OBJECTIVE To understand the impact of pain in Parkinson's and to understand current management and preferences for pain management. METHODS We conducted a national survey with 115 people with Parkinson's (PwP) and 10 carers. Both closed and open questions were used. The questions focused on how pain affected the individual, healthcare professional involvement in supporting pain management, current pain management strategies and views on future pain management interventions. We used descriptive statistics to summarize closed responses and thematic analysis to summarize open question responses. RESULTS 70% of participants reported pain impacted their daily life. Pain had a multifactorial impact on participants, affecting movement, mood and quality of life. Improved pain management was viewed to have the potential to address each of these challenges. Pain affected a number of different sites, with low back pain and multiple sites being most frequently reported. Exercise was the most frequently noted strategy (38%) recommended by healthcare professionals for pain management. PwP would value involvement from healthcare professionals for future pain management, but also would like to self-manage the condition. Medication was not suggested as a first line strategy. CONCLUSIONS Despite reporting engagement in some strategies to manage pain, pain still has a wide-ranging impact on the daily life of PwP. Results from this survey highlight the need to better support PwP to manage the impact of pain.
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Affiliation(s)
- Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom,Clinical Ageing Research Unit, Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Newcastle Upon Tyne, United Kingdom,Jenni Naisby, Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, United Kingdom.
| | | | | | | | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom
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Gao L, Huang W, Cai L, Peng Y. Pain Assessment in Chinese Parkinson’s Disease Patients Using King’s Parkinson’s Disease Pain Scale. J Pain Res 2022; 15:715-722. [PMID: 35300403 PMCID: PMC8922447 DOI: 10.2147/jpr.s353249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Liang Gao
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Weiling Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Laisheng Cai
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Yufen Peng
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Correspondence: Yufen Peng; Liang Gao, Tel +86 791-88692511, Email ;
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Li J, Zhu BF, Gu ZQ, Zhang H, Mei SS, Ji SZ, Liu SY, Han C, Chen HZ, Chan P. Musculoskeletal Pain in Parkinson's Disease. Front Neurol 2022; 12:756538. [PMID: 35126283 PMCID: PMC8813739 DOI: 10.3389/fneur.2021.756538] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Musculoskeletal pain is commonly experienced in patients with Parkinson's disease (PD). Few studies have investigated the clinical characteristics and risk factors associated with musculoskeletal pain. OBJECTIVES To investigate the distribution, clinical characteristics, and factors associated with musculoskeletal pain in a large sample of patients with PD. METHODS We enrolled 452 patients from two clinics and used a standardized questionnaire to collect demographic and clinical information. Musculoskeletal pain was diagnosed based on the Ford Classification System, and pain severity was assessed with the numeric rating scale (NRS). Multivariate regression models explored the association between clinical features of PD and quality of life and pain. RESULTS Two hundred and six patients (45.58%) reported musculoskeletal pain, typically in their lower limbs and backs. Levodopa resulted in a ≥30% reduction in pain intensity scores in 170 subjects. Female sex (odds ratio [OR], 1.57; 95% CI, 1.07-2.29) and Levodopa-equivalent daily doses (LEDDs; OR, 3.35; 95% CI, 1.63-6.59) were associated with an increased risk for musculoskeletal pain. Pain duration (p = 0.017), motor symptoms (p < 0.001), and depression (p < 0.001) were significantly associated with quality of life. CONCLUSIONS The lower limbs and back are common sites of musculoskeletal pain in patients with PD, and up to 82.52% of patients were responsive to Levodopa. Female sex and LEDDs are associated with musculoskeletal pain, suggesting that dopamine deficiencies, and not the motor and non-motor impairment, might be the most critical baseline risk factor of musculoskeletal pain.
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Affiliation(s)
- Jun Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China.,Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ben-Fan Zhu
- Department of Pain, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhu-Qin Gu
- Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China
| | - Hui Zhang
- Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China
| | - Shan-Shan Mei
- Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China
| | - Shao-Zhen Ji
- Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China
| | - Shu-Ying Liu
- Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China
| | - Chao Han
- Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China
| | - Huai-Zhen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Piu Chan
- Department of Neurology, Neurobiology, and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China.,Clinical and Research Center for Parkinson's Disease, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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33
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[The new Parkinson's disease pain classification system (PD-PCS)]. DER NERVENARZT 2022; 93:1019-1027. [PMID: 35089366 PMCID: PMC9534980 DOI: 10.1007/s00115-021-01258-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic pain is a common non-motor symptom in patients with Parkinson's disease (PD). AIM To facilitate the diagnosis of pain in PD, we developed a new classification system the Parkinson's disease pain classification system (PD-PCS) and translated the corresponding validated questionnaire into German. METHODS A causal relationship of the respective pain syndrome with PD can be determined by four questions before assigning it hierarchically into one of three pain categories (neuropathic, nociceptive and nociplastic). RESULTS In the initial validation study 77% of the patients (122/159) had PD-associated pain comprising 87 (55%) with nociceptive, 36 (22%) with nociplastic and 24 (16%) with neuropathic pain. The study revealed a high validity of the questionnaire and a moderate intrarater and interrater reliability. The questionnaire has been adapted into German and employed in 30 patients. DISCUSSION The PD-PCS questionnaire is a valid and reliable tool to determine the relationship of a pain syndrome with PD before classifying it according to the underlying category, facilitating further diagnostics and treatment.
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A nigra-subthalamic circuit is involved in acute and chronic pain states. Pain 2022; 163:1952-1966. [PMID: 35082251 DOI: 10.1097/j.pain.0000000000002588] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT The basal ganglia modulate somatosensory pain pathways but it is unclear whether a common circuit exists to mitigate hyperalgesia in pain states induced by peripheral nociceptive stimuli. As a key output nucleus of the basal ganglia, the substantia nigra pars reticulata (SNr) may be a candidate for this role. To test this possibility, we optogenetically modulated SNr GABAergic neurons and examined pain thresholds in freely behaving male mice in inflammatory and neuropathic pain states as well as comorbid depression in chronic pain. We observed that stimulation of either SNr GABAergic neurons or their projections to the subthalamic nucleus (STN) significantly alleviated nociceptive responses in all pain states on the contralateral side and comorbid depression in chronic pain, and that this analgesic effect was eliminated when SNr-STN GABAergic projection was blocked. However, SNr modulation did not affect baseline pain thresholds. We also found that SNr-STN GABAergic projection was attenuated in pain states, resulting in disinhibition of STN neurons. Thus, impairment of the SNr-STN GABAergic circuit may be a common pathophysiology for the maintenance of hyperalgesia in both inflammatory and neuropathic pain states and the comorbid depression in chronic pain; compensating this circuit has potential to effectively treat related pain conditions.
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35
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Alfaro-Rodriguez A, Cortes-Altamirano J, Reyes-Long S, Bandala C, Morraz-Varela A, Bonilla-Jaime H. Neuropathic Pain in Parkinson's Disease. Neurol India 2022; 70:1879-1886. [DOI: 10.4103/0028-3886.359257] [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]
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Abolarin PO, Nafiu AB, Oyewole AL, Amin A, Ogundele OM, Owoyele BV. Selenium reduces nociceptive response in acute 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP)-induced neurotoxicity. IBRO Neurosci Rep 2021; 12:1-11. [PMID: 34927129 PMCID: PMC8652001 DOI: 10.1016/j.ibneur.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022] Open
Abstract
The potential of Se to alleviate pain associated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurotoxicity was investigated. Swiss mice were intraperitoneally injected with MPTP (20 mg/kg) 4 times with an interval of 2 h in 1 day. Seven days after MPTP injection, the mice (n = 5 mice per group) were randomly assigned to groups: MPTP-, DOPA (50 mg/kg)-, Se4 (0.4 mg/kg)-, Se6 (0.6 mg/kg)-, DOPA+Se4-, and DOPA+Se6-treated groups were compared with controls. MPTP mice were treated for seven days; thereafter, motor-coordination and nociceptive-motor reactions were assessed. Pro-inflammatory cytokines (IL-1β, IL-6 and TNFα), and selected pain biomarkers (substance P (SP), glutamate and β-endorphin) were assessed in the serum and the substantial nigra pars compacta (SNpc). Motor activity was increased slightly by Se (0.6 or 0.4 mg/kg) vs. MPTP (10.48 ± 2.71 or 11.81 ± 1.28 s vs. 3.53 ± 0.06 s respectively) but considerably increased by DOPA (50 mg/kg) vs. MPTP (50.47 ± 3.06 s vs. 3.53 ± 0.06 s respectively). Se and DOPA increased nociceptive threshold but Se alone reduced both serum and SN pro-inflammatory cytokines. Se modulates SP while DOPA modulates SP and glutamate in the SNpc of mice treated with MPTP. Se suppressed pro-inflammatory cytokines and restored the basal pain biomarkers in the SNpc of mice treated with MPTP. Se requires further study as analgesic adjuvant.
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Affiliation(s)
| | | | | | - Abdulbasit Amin
- Department of Physiology, University of Ilorin, P.M.B 1515, Ilorin, Nigeria
| | - Olalekan Michael Ogundele
- Department of Comparative Biomedical Sciences, Louisiana State University, School of Veterinary Medicine, Baton Rouge, LA, USA
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Kurihara K, Fujioka S, Mishima T, Konno T, Seki M, Tsuboi Y. [Japanese translation and linguistic validation of King's Parkinson's Disease Pain Scale (KPPS) and King's Parkinson's Disease Pain Questionnaire (KPPQ)]. Rinsho Shinkeigaku 2021; 62:15-21. [PMID: 34924474 DOI: 10.5692/clinicalneurol.cn-001686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pain is one of the most frequent non-motor symptoms associated with Parkinson's disease (PD) and it has a great impact on patient's quality of life. Thus, its quantitative evaluation is critical in establishing therapeutic evidence. The King's Parkinson's Disease Pain Scale (KPPS) was introduced as a scale of pain specific to PD in 2015. As a follow-up to the evaluator-based KPPS, the patient-based questionnaire, the King's Parkinson's Disease Pain Questionnaire (KPPQ), was introduced in 2018. We developed a linguistically validated Japanese version of the KPPS and KPPQ, and the process of its construction is reported in this study.
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Affiliation(s)
- Kanako Kurihara
- Department of Neurology, Fukuoka University School of Medicine
| | | | | | - Takuya Konno
- Department of Neurology, Brain Research Institute, Niigata University
| | - Morinobu Seki
- Department of Neurology, Keio University School of Medicine
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University School of Medicine
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Roversi K, Callai-Silva N, Roversi K, Griffith M, Boutopoulos C, Prediger RD, Talbot S. Neuro-Immunity and Gut Dysbiosis Drive Parkinson's Disease-Induced Pain. Front Immunol 2021; 12:759679. [PMID: 34868000 PMCID: PMC8637106 DOI: 10.3389/fimmu.2021.759679] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder, affecting 1-2% of the population aged 65 and over. Additionally, non-motor symptoms such as pain and gastrointestinal dysregulation are also common in PD. These impairments might stem from a dysregulation within the gut-brain axis that alters immunity and the inflammatory state and subsequently drives neurodegeneration. There is increasing evidence linking gut dysbiosis to the severity of PD's motor symptoms as well as to somatosensory hypersensitivities. Altogether, these interdependent features highlight the urgency of reviewing the links between the onset of PD's non-motor symptoms and gut immunity and whether such interplays drive the progression of PD. This review will shed light on maladaptive neuro-immune crosstalk in the context of gut dysbiosis and will posit that such deleterious interplays lead to PD-induced pain hypersensitivity.
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Affiliation(s)
- Katiane Roversi
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département d'Ophtalmologie, Université de Montréal, Montréal, QC, Canada.,Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Natalia Callai-Silva
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département d'Ophtalmologie, Université de Montréal, Montréal, QC, Canada
| | - Karine Roversi
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada
| | - May Griffith
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département d'Ophtalmologie, Université de Montréal, Montréal, QC, Canada
| | - Christos Boutopoulos
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département d'Ophtalmologie, Université de Montréal, Montréal, QC, Canada
| | - Rui Daniel Prediger
- Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Sébastien Talbot
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada
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Naisby J, Lawson RA, Galna B, Alcock L, Burn DJ, Rochester L, Yarnall AJ. Trajectories of pain over 6 years in early Parkinson's disease: ICICLE-PD. J Neurol 2021; 268:4759-4767. [PMID: 33991240 PMCID: PMC8563518 DOI: 10.1007/s00415-021-10586-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Pain is a common non-motor symptom in Parkinson's disease (PD), affecting up to 85% of patients. The frequency and stability of pain over time has not been extensively studied. There is a paucity of high-quality studies investigating pain management in PD. To develop interventions, an understanding of how pain changes over the disease course is required. METHODS One hundred and fifty-four participants with early PD and 99 age-and-sex-matched controls were recruited as part of a longitudinal study (Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in PD, ICICLE-PD). Pain data were collected at 18-month intervals over 72 months in both groups using the Nonmotor Symptom Questionnaire (NMSQ), consisting of a binary yes/no response. Two questions from the Parkinson's Disease Questionnaire (PDQ-39) were analysed for the PD group only. RESULTS Unexplained pain was common in the PD group and occurred more frequently than in age-matched controls. 'Aches and pains' occurred more frequently than 'cramps and muscle spasms' at each time point (p < 0.001) except 54 months. CONCLUSIONS This study shows that pain is prevalent even in the early stages of PD, yet the frequency and type of pain fluctuates as symptoms progress. People with PD should be asked about their pain at clinical consultations and given support with describing pain given the different ways this can present.
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Affiliation(s)
- J Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK.
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - R A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - B Galna
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - L Alcock
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - D J Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - L Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - A J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
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Li T, Wang L, Zhang L, Li B, Wang D, Zhang L, Wang T, Fu F. Rotigotine-loaded microspheres exerts the antinociceptive effect via central dopaminergic system. Eur J Pharmacol 2021; 910:174443. [PMID: 34464604 DOI: 10.1016/j.ejphar.2021.174443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022]
Abstract
Rotigotine-loaded microspheres (RoMS), a sustained-release formulation with a continuous release of rotigotine for more than 7 days in vivo, have been conducted a clinical trial for the treatment of Parkinson's disease (PD). Previous work from our laboratory showed that RoMS exerted an antinociceptive effect in rat models of inflammatory pain. The purpose of this study was to investigate the mechanisms of action underlying the antinociceptive effect of RoMS. A rat model of inflammatory pain was prepared by an intraplantar injection of carrageenan. The hot plate test and the Randall-Selitto test were used to evaluate the effect of domperidone (selective D2 receptor antagonist), D2D3 shRNA, and naloxone (nonselective opioid receptor antagonist) on RoMS-mediated antinociceptive efficacy. The expressions of D2 and D3 receptors in the striatum and periaqueductal gray were measured by Western blotting. Intracerebroventricular injection of domperidone abated the antinociceptive effect of RoMS. However, intraperitoneal injection of domperidone had no significant effect on the antinociceptive action of RoMS. Intracerebroventricular injection with D2D3 shRNA significantly attenuated the expressions of D2 and D3 receptors in the striatum and the periaqueductal gray. D2 and D3 receptors silence significantly weakened RoMS-mediated antinociceptive effect. Intracerebroventricular injection of naloxone also alleviated the antinociceptive effect of RoMS. The results suggest that RoMS-mediated antinociceptive efficacy is associated with activating central dopamine D2 and D3 receptors. Opioid receptors play a role in the antinociceptive effect of RoMS.
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Affiliation(s)
- Ting Li
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China
| | - Linlin Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China
| | - Linjie Zhang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China
| | - Baoxia Li
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China
| | - Daohui Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China
| | - Leiming Zhang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China
| | - Tian Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China.
| | - Fenghua Fu
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong, 264005, PR China; State Key Laboratory of Long-acting and Targeting Drug Delivery Technologies, Luye Pharma Group Ltd., Yantai, Shandong, 264003, PR China.
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Kurihara K, Fujioka S, Kawazoe M, Mishima T, Ouma S, Tsuboi Y. Fluctuating pain in Parkinson's disease: Its prevalence and impact on quality of life. eNeurologicalSci 2021; 25:100371. [PMID: 34693041 PMCID: PMC8511840 DOI: 10.1016/j.ensci.2021.100371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/16/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
Pain is a common non-motor symptom in Parkinson's disease (PD) patients, and the incidence of fluctuating pain may be improved by taking levodopa. There are only a few detailed reports regarding fluctuating pain. In this study, 331 PD patients were classified into three groups: no-pain group (67.4%), non-fluctuating pain group (22.1%), and fluctuating pain group (10.6%). We evaluated patients' background and its impact on the quality of life (QOL) of each group. The pain group exhibited higher levels of depression (p < 0.0001), had a higher frequency of visual hallucinations (p = 0.007), and lower QOL (p < 0.0001) compared with the no-pain group. The fluctuating pain group had a younger onset (p = 0.006), higher Hoehn & Yahr stage (p = 0.018), and higher frequency of wearing-off (p < 0.001) and dyskinesia (p = 0.007) than the other groups. We compared the Parkinson's Disease Questionnaire-8 summary index (PDQ-8 SI) in each pain group to the no-pain group using analysis of variance. As a result, PDQ-8 SI was significantly higher in both the non-fluctuating and fluctuating pain groups (p < 0.0001). Pain is regarded as a non-negligible symptom that affects the QOL of PD patients, and given the unique characteristics, fluctuating pain might be considered as an independent clinical subtype of PD. Clinical characteristics of fluctuating pain in Parkinson's disease The prevalence of pain in PD was 10.6%, of which 32.4% showed fluctuating pain. Fluctuating pain is related to younger age of onset and severity of disease. Pain affects the quality of life of patients with Parkinson's disease.
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Affiliation(s)
| | | | - Miki Kawazoe
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | | | - Shinji Ouma
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
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Kurihara K, Mishima T, Fujioka S, Tsuboi Y. Efficacy and safety evaluation of safinamide as an add-on treatment to levodopa for parkinson's disease. Expert Opin Drug Saf 2021; 21:137-147. [PMID: 34597253 DOI: 10.1080/14740338.2022.1988926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While levodopa is still the most effective treatment for Parkinson's disease, concerns about long-term complications such as wearing-off and dyskinesia with levodopa usage remain. AREAS COVERED Safinamide is a highly selective and reversible monoamine oxidase B inhibitor introduced in the European Union, Japan, and the United States as an adjunctive agent to levodopa in PD patients with motor fluctuation. This review outlines the pharmacological properties, therapeutic effects, and tolerability of safinamide as an adjunct to levodopa in patients with advanced PD. Efficacy and safety findings from double-blind and placebo-controlled clinical trials for safinamide as an adjunct therapy to levodopa for PD are summarized. EXPERT OPINION Safinamide was well tolerated as a treatment for PD, and there was no significant difference in the frequency and severity of adverse events between the safinamide and placebo groups. It was also suggested that safinamide had a beneficial effect on the accompanying non-motor symptoms such as PD-related pain. Safinamide may exhibit neuroprotective effects through antioxidant and anti-glutamate effects, and research on the disease-modifying effect of PD is desired in the future.
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Affiliation(s)
| | | | | | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University Fukuoka, Japan
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Tsuboi Y, Koebis M, Kogo Y, Ishida T, Suzuki I, Nomoto M, Hattori N. Effects of safinamide adjunct therapy on pain in patients with Parkinson's disease: Post hoc analysis of a Japanese phase 2/3 study. J Neurol Sci 2021; 429:118070. [PMID: 34509801 DOI: 10.1016/j.jns.2021.118070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The non-dopaminergic and dopaminergic actions of safinamide may alleviate pain in patients with Parkinson's disease (PD). We investigated the efficacy of safinamide for pain when administered as an adjunct to levodopa in Japanese patients with PD. METHODS This was a post hoc analysis of a phase 2/3 clinical study of safinamide in Japanese patients with PD who were experiencing wearing-off. Pain was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) Part II 'sensory symptoms' item 17, on a scale of 0-4, and the 39-item Parkinson's Disease Questionnaire (PDQ-39) 'bodily discomfort' domain score. Subgroup analyses, according to baseline symptoms and concomitant medications, were also performed. RESULTS Least square (LS) mean changes in the UPDRS item 17 score from baseline to Week 24 in the placebo, safinamide 50-mg and safinamide 100-mg groups during the OFF phase were 0.08, -0.15 (p = 0.0133 vs placebo) and -0.18 (p = 0.0054), respectively, and during the ON phase were 0.04, -0.08 (p = 0.0529) and -0.08 (p = 0.0505), respectively. Changes from baseline to Week 24 in PDQ-39 'bodily discomfort' scores were not significantly different in safinamide groups vs placebo. The presence of moderate-to-severe bradykinesia or early-morning dystonia at baseline resulted in numerically greater effect sizes in UPDRS item 17 scores during the OFF phase. CONCLUSIONS Safinamide 50 mg and 100 mg reduced the UPDRS item 17 score in patients with PD, especially during the OFF phase. Patients with moderate-to-severe bradykinesia and early-morning dystonia may benefit from safinamide treatment.
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Affiliation(s)
- Yoshio Tsuboi
- Department of Neurology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Michinori Koebis
- Medical Headquarters, Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan.
| | - Yuki Kogo
- Medical Headquarters, Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan.
| | - Takayuki Ishida
- Medical Headquarters, Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan.
| | - Ippei Suzuki
- Medicine Development Center, Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan.
| | - Masahiro Nomoto
- Saiseikai Imabari Center for Health and Welfare, 7-6-1 Kitamura, Imabari, Ehime 799-1592, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan.
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Tueth LE, Duncan RP. Musculoskeletal pain in Parkinson's disease: a narrative review. Neurodegener Dis Manag 2021; 11:373-385. [PMID: 34410146 PMCID: PMC8515213 DOI: 10.2217/nmt-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
The prevalence of musculoskeletal (MSK) pain in people with Parkinson's disease (PD) is higher than that of age-matched controls. In this review, we outline what is known about MSK pain in PD, focusing on the neck, shoulder, knee, hip and low back. We also compare what is known about MSK pain in PD to what is known in older adults without PD. Finally, we outline areas of for future research related to MSK pain in people with PD.
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Affiliation(s)
- Lauren Elizabeth Tueth
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Ryan P Duncan
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
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Stoyanova-Piroth G, Milanov I, Stambolieva K. Translation, adaptation and validation of the Bulgarian version of the King's Parkinson's Disease Pain Scale. BMC Neurol 2021; 21:357. [PMID: 34525961 PMCID: PMC8442462 DOI: 10.1186/s12883-021-02392-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of the present study was to translate and cross-culturally adapt the King’s Parkinson’s Disease Pain Scale (KPPS) into Bulgarian and to investigate its psychometric properties in order to provide a validated Parkinson’s disease-specific pain instrument in Bulgarian language (KPPS-BG). Methods Translation into Bulgarian and a cultural adaptation were performed to obtain KPPS-BG. A total of 162 patients with idiopathic Parkinson’s disease were screened for pain using the complementary to the KPPS questionnaire – King’s Parkinson’s Disease Pain Questionnaire (KPPQ). KPPS-BG domain and total scores were calculated and internal consistency, construct validity and test-retest reliability were examined for 129 patients having one or more positive items in the KPPQ-BG. Results 79.6 % of the patients reported one or more types of pain. The most common type was musculoskeletal pain (83.7 %), followed by nocturnal pain (55.0 %), fluctuation-related pain (50.1 %), radicular pain (43.4 %), chronic pain (31.0 %), discoloration, edema/swelling (27.1 %) and, oro-facial pain (14.3 %). Mean KPPS-BG total score was 21.1 ± 17.3 SD. KPPS-BG showed a good reliability (Cronbach’s alpha 0.75). The test-retest reliability of the KPPS-BG was high and the intraclass correlation coefficient was 0.92, demonstrating а good repeatability. KPPS-BG total score was higher in patients with postural instability gait difficulty motor subtype, compared to tremor-dominant or indeterminate subtype. Significant positive correlations were found between KPPS-BG total score and modified H&Y, Movement Disorders Society Unified Parkinson’s Disease Rating Scale part III. Conclusions The KPPS-BG constitutes a reliable, comprehensive and useful tool for pain assessment in native Bulgarian patients with Parkinson’s disease.
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Affiliation(s)
- Galina Stoyanova-Piroth
- St. Naum Hospital of Neurology and Psychiatry, Medical University, 1, Louben Roussev str., 1113, Sofia, Bulgaria.
| | - Ivan Milanov
- St. Naum Hospital of Neurology and Psychiatry, Medical University, 1, Louben Roussev str., 1113, Sofia, Bulgaria
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Santos García D, Yáñez Baña R, Labandeira Guerra C, Cimas Hernando MI, Cabo López I, Paz González JM, Alonso Losada MG, Gonzalez Palmás MJ, Cores Bartolomé C, Martínez Miró C. Pain Improvement in Parkinson's Disease Patients Treated with Safinamide: Results from the SAFINONMOTOR Study. J Pers Med 2021; 11:jpm11080798. [PMID: 34442442 PMCID: PMC8402181 DOI: 10.3390/jpm11080798] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/30/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background and objective: Pain is a frequent and disabling symptom in Parkinson’s disease (PD) patients. Our aim was to analyze the effectiveness of safinamide on pain in PD patients from the SAFINONMOTOR (an open-label study of the effectiveness of SAFInamide on NON-MOTOR symptoms in Parkinson´s disease patients) study. Material and Methods: SAFINONMOTOR is a prospective open-label single-arm study conducted in five centers from Spain. In this analysis, a secondary objective of the study, the score in the KPPS (King´s Parkinson´s Disease Pain Scale) at V1 (baseline) and V4 (6 months ± 1 month) were compared. Wilcoxon´s rank sum test was performed to test the changes from V1 to V4. Results: Forty-four (88%) out of 50 PD patients (age 68.5 ± 9.12 years; 58% women; 6.4 ± 5.1 years from diagnosis) completed the study. The KPPS total score was reduced by 43.6% (from 40.04 ± 36.18 in V1 to 22.60 ± 21.42 in V4; p < 0.0001). By domains, improvement was observed in musculoskeletal (−35.9%; p = 0.009), fluctuation-related (−51.7%; p = 0.020), nocturnal (−46.1%; p = 0.001), discoloration and/or edema/swelling (−50.4%; p = 0.009) and radicular pain (−40.1%; p = 0.048). A total of 21 adverse events in 11 patients (22%) were reported, five being severe, but not related to safinamide. Conclusion: Safinamide is well tolerated and improves pain in PD patients at 6 months. Future studies are necessary to analyze the possible beneficial effect of safinamide on pain in PD patients.
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Affiliation(s)
- Diego Santos García
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
- Correspondence: ; Tel.: +34-646173341
| | - Rosa Yáñez Baña
- Department of Neurology, CHUO, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Carmen Labandeira Guerra
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | | | - Iria Cabo López
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Jose Manuel Paz González
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
| | - Maria Gema Alonso Losada
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - Maria José Gonzalez Palmás
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Carlos Cores Bartolomé
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
| | - Cristina Martínez Miró
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.C.B.); (C.M.M.)
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Cannabidiol has therapeutic potential for myofascial pain in female and male parkinsonian rats. Neuropharmacology 2021; 196:108700. [PMID: 34246682 DOI: 10.1016/j.neuropharm.2021.108700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
The musculoskeletal orofacial pain is a complex symptom of Parkinson's disease (PD) resulting in stomatognathic system dysfunctions aggravated by the disease rigidity and postural instability. We tested the effect of cannabidiol (CBD), a non-psychotomimetic constituent of Cannabis sativa, in PD-related myofascial pain. Wistar adult female and male rats orofacial allodynic and hyperalgesic responses were tested by Von Frey and formalin tests, before and 21 days past 6-OHDA lesion. Algesic response was tested after masseter muscle injection of CBD (10, 50, 100 μg in 10 μL) or vehicle. Males compared to females in all estrous cycles' phases presented reduced orofacial allodynia and hyperalgesia. According to the estrous cycle's phases, females presented distinct orofacial nociceptive responses, being the estrus phase well-chosen for nociceptive analysis after 6-OHDA lesion (phase with fewer hormone alterations and adequate length). Dopaminergic neuron lesion decreased mechanical and inflammatory nociceptive thresholds in females and males in a higher proportion in females. CBD local treatment reduced the increased orofacial allodynia and hyperalgesia, in males and females. The female rats were more sensitive to CBD effect considering allodynia, responding to the lowest dose. Although females and males respond to the effect of three doses of CBD in the formalin test, males showed a superior reduction in the hyperalgesic response. These results indicate that hemiparkinsonian female in the estrus phase and male answer differently to the different doses of CBD therapy and nociceptive tests. CBD therapy is effective for parkinsonism-induced orofacial nociception.
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Mylius V, Möller JC, Bohlhalter S, Ciampi de Andrade D, Perez Lloret S. Diagnosis and Management of Pain in Parkinson's Disease: A New Approach. Drugs Aging 2021; 38:559-577. [PMID: 34224103 DOI: 10.1007/s40266-021-00867-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Pain is a frequent and disabling non-motor feature of Parkinson's disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, 7317, Valens, Switzerland. .,Department of Neurology, Philipps University, Marburg, Germany. .,Department of Neurology, Kantonsspital, St. Gallen, Switzerland.
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany.,Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto do Cancer de Sao Paulo, Octavio Frias de Oliveira, Sao Paulo, Brazil.,Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Santiago Perez Lloret
- LIM 62, Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina.,Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.,Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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49
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Sprenger GP, Roos RAC, van Zwet E, Reijntjes RH, Achterberg WP, de Bot ST. The prevalence of pain in Huntington's disease in a large worldwide cohort. Parkinsonism Relat Disord 2021; 89:73-78. [PMID: 34243026 DOI: 10.1016/j.parkreldis.2021.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 06/05/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pain could be an unknown non-motor symptom in Huntington's Disease (HD). The aim is therefore, to study the prevalence of pain interference, painful conditions and analgesic use across the different stages of HD and compare these levels to non-HD gene mutation carriers. METHODS A cross-sectional analysis of the Enroll-HD study was conducted in premanifest, manifest HD gene mutation carriers (n = 3989 and n = 7,485, respectively) and in non-HD gene mutation carriers (n = 3719). To investigate group differences, multivariable logistic regression analysis was performed with pairwise comparisons. RESULTS In the HD mutation carriers, the overall prevalence of pain interference was 34% (95% CI 31%-35%), of painful conditions 17% (95% CI 15%-19%) and analgesic use 13% (95% CI 11%-15%). Compared to non-mutation carriers, the prevalence of pain interference was significantly higher in the middle stage of HD (33% [95% CI 31%-35%] vs 42% [95% CI 39%-45%], P = 0,02), whereas the prevalence of painful conditions was significant lower in the late and middle stage of HD (17% [95% CI 16%-18%] vs 12% [95% CI 10%-14%], 15% [95% CI 13%-17%], P < 0,01]. No significant group difference was present in analgesic use. CONCLUSIONS The prevalence of pain interference increases as HD progresses, however, the prevalence of painful conditions and analgesics do not increase accordingly. Further studies are necessary to investigate the aetiology of pain in HD and the risk for undertreatment of pain.
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Affiliation(s)
- Gregory P Sprenger
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Amstelring, Huntington Center, Amsterdam, the Netherlands.
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert H Reijntjes
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Topaz Huntington Center Overduin, Katwijk, the Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Shraim MA, Massé-Alarie H, Hodges PW. Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review. Pain 2021; 162:1007-1037. [PMID: 33136983 DOI: 10.1097/j.pain.0000000000002113] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022]
Abstract
ABSTRACT Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
- Centre Interdisciplinaire de recherche en réadaptation et Integration sociale (CIRRIS), Université Laval, Québec, QC, Canada
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
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