Chronic pain is highly common in people with Parkinson’s disease.

In fact, people living with PD are twice as likely to experience pain as those without, and 80% of people with PD report experiencing chronic pain. These pains can be both motor-related (associated with movement) and non-motor-related (not directly tied to movement).

The good news is many effective ways to manage these symptoms exist. As is the case for most aspects of Parkinson’s disease, your experience with pain and treatment will be highly individual.

The first step is to consult with your healthcare provider or movement disorder specialist and explore how to specialize your management tactics to the symptoms you are experiencing.

Here are the types of pain you may experience with Parkinson’s disease, possible causes, and options for treatment.

Types of Pain in PD

“Pain” is a generalized term, but there are some very specific ways it manifests in those living with Parkinson’s Disease.

Musculoskeletal Pain

This type of pain is common in Parkinson’s disease and specific to muscle, bone, and joint pain. It’s also typically linked to motor symptoms such as rigidity, tremors, muscle cramps, and bradykinesia (slow movement).

While PD doesn’t necessarily cause musculoskeletal pain, it can worsen it and often arises from muscle stiffness, tension, and cramping due to motor fluctuations and changes in posture.

Dystonia-Related Pain

Dystonia is a movement disorder and symptom of PD characterized by involuntary muscle contractions that lead to abnormal postures or repetitive movements. These contractions can cause pain, particularly cramping or twisting sensations and curling of the toes, feet, and hands.

Dystonic pain often occurs in the morning and can be a side-effect of levodopa, a common treatment for PD symptoms.

Central Pain

Central pain refers to pain originating from the central nervous system itself. It can be one of the more difficult pains to pinpoint and varies significantly from person to person.

This type of pain can manifest as an aching, tingling, or burning sensation throughout all areas of the body, particularly the abdomen, mouth, genitals, and sometimes all over. People with Parkinson’s disease may experience central pain due to changes in how the brain processes sensory signals.

Radicular Pain

Radicular pain, also known as neuropathic pain, results from compression or irritation of spinal nerve roots.

In Parkinson’s disease, changes in posture and musculoskeletal rigidity can contribute to nerve compression, leading to pain that radiates along the affected nerve pathway. It’s often experienced as sharp or electric pain but can also include numbness or tingling in the toes or fingertips due to peripheral neuropathy.

Causes of Pain in PD

The causes of pain in Parkinson’s disease are multifaceted and can result from the underlying neurodegenerative process, altered sensory processing, medication side effects, and musculoskeletal changes.

Neurodegeneration

The progressive degeneration of dopamine-producing neurons in the brain, a hallmark of Parkinson’s disease, can disrupt pain processing pathways and lead to altered perceptions of pain.

Musculoskeletal Changes

Rigidity, bradykinesia, and changes in posture can strain muscles and joints, leading to discomfort and pain.

Medication Side Effects

Some medications used to manage Parkinson’s symptoms can cause side effects like dyskinesias (involuntary movements), which may contribute to pain.

How to Manage Pain with PD

There are several tried and tested methods of pain management for people living with Parkinson’s, and your healthcare team can help to narrow down the options for the specific pain you experience.

Here are a few ways to approach pain management with Parkinson’s disease.

Medications

Depending on the type and severity of pain, doctors may prescribe medication to treat pain such as nonsteroidal anti-inflammatory drugs (NSAIDs) or antispasmodic medications for pain management.

Popular NSAIDs include ibuprofen, naproxen, and acetaminophen. These types of medications are generally well-tolerated by people with PD due to their non-neurological nature.

Additionally, your doctor may explore medications targeting nerve-related pains, such as gabapentin, duloxetine, and pregabalin. These are taken daily to manage symptoms over time rather than on a needed basis as pain arises.

In some cases, your doctor may explore medications that target the specific source of pain or area where pain occurs. These could include muscle relaxants that alleviate dystonia, such as deep brain stimulation or botulinum toxin (commonly known as Botox).

Further, if pain is associated with medication side effects, adjustments to medication doses or schedules may help alleviate discomfort.

Medical Marijuana

Scientific studies are ongoing on the impact of medical marijuana on Parkinson’s disease, but initial research has yielded positive results. Recent studies have revealed that cannabis effectively reduces anxiety and depression, tremors, rigidity, and chronic pain.

Physical Therapy

Physical therapy can help alleviate musculoskeletal pain by improving mobility, flexibility, and posture. It can also address dystonia-related pain and improve overall motor function.

Speak with your doctor or movement disorder specialist for a referral to the appropriate physical therapist based on the pain you’re experiencing.

Complementary Therapies

Complementary treatments are those that take a more holistic approach to the treatment of PD symptoms and pain. These include acupuncture, massage therapy, and even music and art therapies.

While many people with PD report positively on the impact of complementary therapies, little research has been conducted to support the effectiveness of these methods.

Exercise and Movement

While exercise may be the last thing you want to do while in pain, it can significantly alleviate symptoms in the long term.

Regular exercise, including stretching, yoga, and tai chi, can improve muscle flexibility, strength, and overall well-being, encouraging full-body wellness and potentially reducing pain.

Psychological Interventions

Chronic pain often leads to depression in people living with PD. Techniques such as cognitive-behavioral therapy and mindfulness meditation can help individuals manage pain perception and cope with the emotional aspects of pain.

Pain & Parkinson’s: Finding Support

Pain and Parkinson’s may frequently go together, but that doesn’t mean you must endure it alone. The first step in treating pain is to speak with your healthcare provider or care team. They can help walk you through diagnosis and treatment plans and ensure you receive support at every step.

Additionally, PCLA offers weekly and monthly support groups and events where you can connect with others in the PD community about your experiences. This is a great way to get advice and referrals from people you trust.

We also regularly host health professionals from the PD community to share their expertise on important topics, such as this talk on Managing Pain in Parkinson’s with Dr. Apurva Zawar.

Access the calendar of events here for full details on what we have planned for the month!