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.
Background: These days, many kinds of locomotive pain can be controlled by new analgesics, involving pregabalin and tramadol preparation, however, it has been hard to control neuropathic pain or painful numbness after spinal operations even if we use many analgesics. Duloxetine hydrochloride (DLX) is the first or second choice in the guideline for the treatment of neuropathic pain in many countries. We examined the effect of DLX in the treatment of “locomotive” neuropathic pain.
Methods: This study was conducted from April 2011 to August 2015 retrospectively. 56 outpatients (average age = 70.7 years old). The primary study was checked the concomitant drugs, the effect of DLX, and adverse drug reactions. The second study was compared age, underlying disease, disease duration, the dose and administration of DLX, and affinity to the concomitant drug (Pregabalin and Tramadol) between good responder group and poor responder group.
Results: The concomitant drugs were Pregabalin (29.1%), the Tramadol preparation (20.3%), NSAIDs (12.7%), and so on. The outcome of DLX was good course was 48% and worse course was 31%. The adverse reactions were occurred in 19.6% of all patients. Most of post operative pain of cervical and lumbar spine were included in good course group. However, age, disease duration, the concomitant drugs, and the dose of DLX were not differentiated significantly between two groups.
Conclusions: DLX was an important treatment option for post operative pain of cervical and lumbar spine.
Introduction: In a retrospective study on patients with zoster–associated pain, we reported the patients were associated with various neuropathic pain components and high VAS values regardless of their disease stages. In the present study, we prospectively followed another group of patients to evaluate those components in each of the stages.
Subjects: The subject group was comprised of 76 patients who first visited our clinic between June 2013 and January 2015 with their onsets of zoster–associated pain within 30 days of the first visits.
Methods: Two neuropathic pain screening questionnaires including the Neuropathic Pain Screening Questionnaire (Japan–Q) and the Pain DETECT Questionnaire (PDQ) were used to track the patients for six months. The questionnaires and Visual Analogue Scale (VAS) evaluations were conducted at each of the acute stage (up to 30 days from the onset), the subacute stage (one to three months) and the chronic stage (the fourth month and after).
Results: Sixty–four patients remained in the subject group throughout the course of the study. The median values of the scores at the acute: subacute: chronic stages were 12 : 4 : 3 for Japan–Q, 15 : 9 : 7 for PDQ and 71.5 : 27.5 : 9.5 for VAS (mm). The numbers of patients with neuropathic pain components more strongly manifested at those stages were 53 (68%) : 14 (18%) : 10 (13%) for Japan–Q scores of 9 or higher and 61 (78%) : 35 (45%) : 21 (27%) for PDQ of 11 or higher. The correlation coefficients between the Japan–Q scores and VAS at the stages were 0.38 : 0.38 : 0.46 while the same between the PDQ scores and VAS were 0.42 : 0.29 : 0.44 indicating moderate correlations at the chronic stage of the pain with both of the questionnaires.
Discussion: While dermatitis and neuritis are common complications of herpes zoster, the fact that the patients experiencing intense pain in the acute phase exhibit neuropathic pain components may suggest the severity of neuritis is more manifested than the other complication. Although the patients diagnosed in our clinic in their acute stages exhibited high scores for the neuropathic pain components and VAS, both declined over time suggesting early intervention by pain specialists may be useful in achieving good therapeutic outcomes, even though spontaneous remission may not be completely ruled out.