Abstract
Background
Pain is a well recognized feature of Parkinson disease (PD). Like motor fluctuations, pain in PD may fluctuate as ‘non-motor fluctuations’. Subthalamic deep brain stimulation (STN DBS) is an established treatment for motor fluctuations in PD. However, the effect of STN DBS on the pain in PD is only partially investigated.
Methods
PD patients who were considered for STN DBS were asked if they had pain. The severity of pain was scored in each body part. In patients with motor fluctuation, the pain in the ‘on’ and ‘off ’ state were recorded separately. Patients were evaluated preoperatively and 3 months after surgery. Some patients were followed for 6 months.
Results
Twenty-three of 29 patients had pain preoperatively. Of 24 with motor fluctuation, 21 had pain, and 18 had fluctuating pain. Pain improved in 20 out of 23 with preoperative pain at 3 months postoperatively. Of 18 with fluctuating pain, 12 reported a decrease in, and 5 complete disappearance of the ‘off ’ pain. Of 4 with nonfluctuating preoperative pain, 2 reported improvement. Pain was severe and functionally disabling in some. The STN DBS improved pain to a tolerable degree. In 7 of 29, new pain developed during the 3 month follow-up. Sixteen patients were followed for 6 months. All 11 patients who had improvement at 3 months continued to get benefit from STN DBS. Two additional patients who had no improvement at 3 months reported improvement at 6 months.
Conclusions
Pain is frequent in PD and STN DBS improves pain, especially the ‘off ’ pain in PD.
Similar content being viewed by others
References
Baron MS, Vitek JL, Bakay RA, Green J, Kaneoke Y, Hashimoto T, Turner RS (1996) Treatment of advanced Parkinson’s disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann Neurol 40:355–366
Brooks DJ, Playford ED, Ibantz V, Sawle GV, Thompson PD, Findley LJ, Marsden CD (1992) Isolated tremor and disruption of the nigrostriatal dopaminergic system. An F18-dopa PET study. Neurology 42:1554–1560
Chudler EH, Dong WK (1995) The role of the basal ganglia in nociception and pain. Pain 60:3–38
Djaldetti R, Shifrin A, Rogowski Z, Sprecher E, Melamed E, Yarnitsky D (2004) Quantitative measurement of pain sensation in patients with Parkinson disease. Neurology 62:2171–2175
Dostrovsky JO, Lozano AM (2002) Mechanisms of deep brain stimulation. Mov Disord 17(Suppl. 3):S63–S68
Ford B (1998) Pain in Parkinson’s disease. Clin Neurosci 5:63–72
Gao X, Zhang Y, Wu G (2000) Effects of dopaminergic agents on carrageenan hyperalgesia in rats. Eur J Pharmacol 406:53–58
Garcia L, D’Alessandro G, Bioulac B, Hammond C (2005) High-frequency stimulation in Parkinson’s disease: more or less? Trends Neurosci 28:209–216
Giuffrida R, Vingerhoets FJ, Bogousslavsky J, Ghika J (2005) Pain in Parkinson’s disease. Rev Neurol (Paris) 161:407–418
Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC (1986) Pain in Parkinson’s disease. Mov Disord 1:45–49
Hagelberg N, Jaaskelainen SK, Martikainen IK, Mansikka H, Forssell H, Scheinin H, Hietala J, Pertovaara A (2004) Striatal dopamine D2 receptors in modulation of pain in humans: a review. Eur J Pharmacol 500:187–192
Honey CR, Phil D, Stoessl AJ, Tsui JKC, Schulzer M, Calne DB (1999) Unilateral pallidotomy for reduction of parkinsonian pain. J Neurosurg 91:198–201
Josephs KA, Matsumoto JY, Ahlskog JE (2006) Benign tremulous parkinsonism. Arch Neurol 63:354–357
Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A (2003) Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 349:1925–1934
Krack P, Pollak P, Limousin P, Benazzouz A, Deuschl G, Benabid A-L (1999) From off-period dystonia to peak-dose chorea: the clinical spectrum of varying subthalamic nucleus activity. Brain 122:1133–1146
Laitinen LV, Bergenheim AT, Hariz MI (1992) Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease. J Neurosurg 76:53–61
Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid A-L (1998) Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 339:1105–1111
Loher TJ, Burgunder J-M, Weber S, Sommerhalder R, Krauss JK (2002) Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson’s disease. J Neurol Neurosurg Psychiatry 73:395–399
Magnusson JE, Fisher K (2000) The involvement of dopamine in nociception: the role of D1 and D2 receptors in the dorsolateral striatum. Brain Res 855:260–266
Quinn NP (1998) Classification of fluctuations in patients with Parkinson’s disease. Neurology 51(Suppl 2):S25–S29
Quinn NP, Koller WC, Lang AE, Marsden CD (1986) Painful Parkinson’s disease. Lancet 1:1366–1369
Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto J-L, Pollak P, Rehncrona S, Kuilsevsky J (2005) Bilateral deep brain stimulation in Parkinson’s disease: a multicentre study with 4 years followup. Brain 128:2240–2249
Snider SR, Fahn S, Isgreen WP, Cote LJ (1976) Primary sensory symptoms in parkinsonism. Neurology 26:423–429
Tinazzi M, Vesco CD, Fincati E, Ottaviani S, Smania N, Moretto G, Fiaschi A, Martino D, Defazio G (2006) Pain and motor complications in Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:822–825
Waseem S, Gwinn-Hardy K (2001) Pain in Parkinson’s disease: common yet seldom recognized symptom is treatable. Postgrad Med 110:33–40
Witjas T, Kaphan E, Azulay JP, Blin O, Ceccaldi M, Pouget J, Poncet M, Cherif AA (2002) Nonmotor fluctuations in Parkinson’s disease. Neurology 59:408–413
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Kim, HJ., Paek, S.H., Kim, JY. et al. Chronic subthalamic deep brain stimulation improves pain in Parkinson disease. J Neurol 255, 1889–1894 (2008). https://doi.org/10.1007/s00415-009-0908-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-009-0908-0