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Al-Wardat M, Grillo P, Schirinzi T, Pavese C, Salimei C, Pisani A, Natoli S. Constipation and pain in Parkinson's disease: a clinical analysis. J Neural Transm (Vienna) 2024; 131:165-172. [PMID: 37897509 PMCID: PMC10791917 DOI: 10.1007/s00702-023-02696-5] [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: 07/29/2023] [Accepted: 09/06/2023] [Indexed: 10/30/2023]
Abstract
Parkinson's Disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms (NMS). Among NMS, constipation and pain are both highly prevalent and debilitating affecting up to 80% of PD patients and impairing their quality of life. Here, we investigated the relationship between constipation and pain in PD patients. This is a retrospective study assessing the relationship between pain and constipation in a PD patient population from a clinical database of patients attending the outpatient clinic of the movement disorders division, Neurology Unit of Policlinico Tor Vergata, in Rome. Subjects were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) part III, Hoehn and Yahr (H&Y) stage, King's Parkinson's Disease Pain Scale (KPPS), Brief Pain Inventory (BPI), Non-Motor Symptoms Scale (NMSS) and Beck Depression Inventory (BDI). Patients were further divided in two groups (Group 1, 32 patients with constipation and Group 2, 35 PD patients without constipation) ANOVA and ANCOVA analysis were used to compare the two groups. PD patients with constipation had significantly higher pain severity and pain interference, as measured by the BPI scale and higher total KPPS score, fluctuation-related pain, nocturnal pain, and radicular pain when compared to PD patients without constipation. This study highlights for the first time a possible interplay between constipation and pain in PD that deserves further investigations.
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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
| | - Piergiorgio Grillo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Tommaso Schirinzi
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, 00133, Rome, Italy
| | - Chiara Pavese
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit of Pavia Institute, Pavia, Italy
| | - Chiara Salimei
- Deptartment of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Silvia Natoli
- Deptartment of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.
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Hoang DT, Xing F, Nguyen TD, Nguyen TD, Tran TN, Nhu SD, Nguyen QH, Nguyen HT, Hoang UT, Than QV, Truong D. Pain is common in early onset Parkinson's disease and pain severity is associated with age and worsening of motor and non-motor symptoms. J Neurol Sci 2023; 455:122784. [PMID: 38043181 DOI: 10.1016/j.jns.2023.122784] [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: 07/27/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Abstract
The consequences of pain in early onset Parkinson's disease (EOPD) remain under appreciated even though pain may exert an increasingly negative impact on patient quality of life as motor and non-motor symptoms worsen. In this prospective study, we investigate the prevalence and severity of pain in 135 Vietnamese patients with EOPD from three medical centers using the King's PD Pain Scale (KPPS), the Mini Mental Status Exam (MMSE), the Unified Parkinson's Disease Rating Scale (UPDRS) and the Non-Motor Symptoms Scale (NMSS). Pain was reported by 79.3%. The most common subtype of pain was musculoskeletal (70.1%), followed by nocturnal (43.9%), radicular (43.0%), chronic (42.1%), fluctuation-related (34.6%) and orofacial pain (16.8%). Most patients (74.8%) experienced more than one pain subtype. Fluctuation-related pain and orofacial pain were significantly more prevalent among patients with higher Hoehn & Yahr (H&Y) stages (3-5) versus lower H&Y stages (1-2). Pain subtype and severity were not significantly related to gender or age of PD onset. Patients with H&Y stages 3-5 had statistically significantly higher KPPS scores for fluctuation-related pain (p = 0.018) and radicular pain (p = 0.026). Independent associations were found between pain severity and age (p = 0.028), depression severity (p = 0.018), perceptual problems/hallucinations (p = 0.033) and sexual function (p = 0.024). Patients with depression and higher H&Y stages (3-5) had statistically significantly higher mean KPPS scores versus patients without depression and at lower H&Y stages (1-2). Pain may be more common and severe in EOPD patients than previously appreciated. Older age, depression, perceptual problems/hallucinations and sexual dysfunction were independently associated with higher pain severity.
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Affiliation(s)
- Dung Thi Hoang
- Department of Neurology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Viet Nam.
| | - Frank Xing
- The Truong Neuroscience Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA 92708, USA.
| | - Thuan Duc Nguyen
- Department of Neurology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Viet Nam.
| | - Ton Dang Nguyen
- Institute of Genome Research, Vietnam Academy of Science and Technology, Cau Giay, Hanoi, Viet Nam.
| | - Tai Ngoc Tran
- University Medical Center HCMC, University of Medicine and Pharmacy at HCMC, Ho Chi Minh City, Viet Nam.
| | - Son Dinh Nhu
- Department of Neurology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Viet Nam
| | | | - Hai Thanh Nguyen
- Department of Neurology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Viet Nam
| | - Ung Tien Hoang
- Department of Rehabilitation, Military Hospital 103, Vietnam Military Medical University, Hanoi, Viet Nam
| | | | - Daniel Truong
- The Truong Neurosciences Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA 92708, USA; Department of Neurosciences, UC Riverside, Riverside, CA, United States of America.
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Candel-Parra E, Córcoles-Jiménez MP, Delicado-Useros V, Hernández-Martínez A, Molina-Alarcón M. Relationship between Motor and Nonmotor Symptoms and Quality of Life in Patients with Parkinson's Disease. NURSING REPORTS 2021; 12:1-12. [PMID: 35076598 PMCID: PMC8788427 DOI: 10.3390/nursrep12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Parkinson’s disease (PD) is a chronic neurodegenerative disease that implies a progressive and invalidating functional organic disorder, which continues to evolve till the end of life and causes different mental and physical alterations that influence the quality of life of those affected. Objective: To determine the relationship between motor and nonmotor symptoms and the quality of life of persons with PD. Methods: An analytic, descriptive, cross-sectional study was conducted with patients with different degrees of PD in the Albacete Health district. The estimated sample size required was 155 patients. The instruments used for data collection included a purpose-designed questionnaire and “Parkinson’s Disease Questionnaire” (PDQ-39), which measures eight dimensions and has a global index where a higher score indicates a worse quality of life. A descriptive and bivariate analysis was conducted (SPSS® IBM 24.0). Ethical aspects: informed consent and anonymized data. Results: A strong correlation was found between the number of motor and nonmotor symptoms and global health-related quality of life and the domains mobility, activities of daily living, emotional well-being, cognitive status, and pain (p < 0.05). Receiving pharmacological treatment and taking more than four medicines per day was significantly associated with a worse quality of life (p < 0.05). Patients who had undergone surgical treatment did not show better global quality of life (p = 0.076). Conclusions: All nonmotor symptoms and polypharmacy were significantly associated with a worse global quality of life.
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Affiliation(s)
- Eduardo Candel-Parra
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Av. de España, s/n, 02001 Albacete, Spain; (E.C.-P.); (M.P.C.-J.); (V.D.-U.)
| | - María Pilar Córcoles-Jiménez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Av. de España, s/n, 02001 Albacete, Spain; (E.C.-P.); (M.P.C.-J.); (V.D.-U.)
| | - Victoria Delicado-Useros
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Av. de España, s/n, 02001 Albacete, Spain; (E.C.-P.); (M.P.C.-J.); (V.D.-U.)
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Av. de España, s/n, 02001 Albacete, Spain; (E.C.-P.); (M.P.C.-J.); (V.D.-U.)
- Instituto de Investigación en Discapacidades Neurológicas (IDINE), University of Castilla-La Mancha, Av. de España, s/n, 02001 Albacete, Spain
- Correspondence: (A.H.-M.); (M.M.-A.)
| | - Milagros Molina-Alarcón
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Av. de España, s/n, 02001 Albacete, Spain; (E.C.-P.); (M.P.C.-J.); (V.D.-U.)
- Instituto de Investigación en Discapacidades Neurológicas (IDINE), University of Castilla-La Mancha, Av. de España, s/n, 02001 Albacete, Spain
- Correspondence: (A.H.-M.); (M.M.-A.)
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Buhmann C, Kassubek J, Jost WH. Management of Pain in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:S37-S48. [PMID: 32568113 PMCID: PMC7592654 DOI: 10.3233/jpd-202069] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pain is a very frequent symptom with influence on the quality of life in Parkinson’s disease (PD), but is still underdiagnosed and commonly treated only unsystematically. Pain etiology and pain character are often complex and multi-causal, and data regarding treatment recommendations are limited. Pain can be primarily related to PD but frequently it is associated with secondary diseases, such as arthrosis of the spine or joints. However, even basically PD-unrelated pain often is amplified by motor- or non-motor PD symptoms, such as akinesia or depression. Beyond an optimization of anti-parkinsonian treatment, additional pain treatment strategies are usually needed to properly address pain in PD. A careful pain history and diagnostic work-up is essential to rate the underlying pain pathophysiology and to develop a targeted therapeutic concept. This review gives an overview on how pain is treated in PD patients and how patients assess the effectiveness of these therapies; here, the manuscript focuses on pathophysiology-driven suggestions for a multimodal pain management in clinical practice.
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Affiliation(s)
- Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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