Pathophysiology and clinical management of pain in Parkinson's disease: Differences in efficacy of dopamine agonists and deep brain stimulation

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   Although different types of pain may be present from the early stage of Parkinson’s disease (PD), musculoskeletal pain related to an impaired motor status is most commonly encountered in clinical practice. Levodopa is widely for the treatment of PD and can substantially improve symptoms. However, prolonged treatment with levodopa can induce serious motor complications, which in turn may trigger or aggravate pain. It has been reported that dopamine agonists, when used in conjunction with levodopa, significantly improve levodopa–induced motor complications. A randomized placebo controlled study has demonstrated that transdermal rotigotine improves pain related to motor fluctuations. Deep brain stimulation (DBS) is a promising method of improving levodopa–induced complications in advanced PD patients, and subthalamic DBS has been shown to be particularly beneficial for nonmotor symptoms including pain. While newer effective methods are expected to be in development for PD–related pain, here, we review current approaches to pain management in PD.