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Diagnosis and Management of Pain in Parkinson's Disease: A New Approach

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Abstract

Pain is a frequent and disabling non-motor feature of Parkinson’s disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.

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Acknowledgements

We thank Prof. Stefan Bachmann from Department of Rheumatology at Kliniken Valens for his revision of the section on pain therapy in older adults. We thank the patients for their participation within the conducted research projects.

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Authors and Affiliations

  1. Department of Neurology, Center for Neurorehabilitation, 7317, Valens, Switzerland

    Veit Mylius

  2. Department of Neurology, Philipps University, Marburg, Germany

    Veit Mylius & Jens Carsten Möller

  3. Department of Neurology, Kantonsspital, St. Gallen, Switzerland

    Veit Mylius

  4. Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland

    Jens Carsten Möller

  5. Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland

    Stephan Bohlhalter

  6. Department of Neurology, University of Zurich, Zurich, Switzerland

    Stephan Bohlhalter

  7. Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil

    Daniel Ciampi de Andrade

  8. Instituto do Cancer de Sao Paulo, Octavio Frias de Oliveira, Sao Paulo, Brazil

    Daniel Ciampi de Andrade

  9. Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil

    Daniel Ciampi de Andrade

  10. LIM 62, Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina

    Santiago Perez Lloret

  11. Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina

    Santiago Perez Lloret

  12. Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina

    Santiago Perez Lloret

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  1. Veit Mylius
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  2. Jens Carsten Möller
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  3. Stephan Bohlhalter
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  4. Daniel Ciampi de Andrade
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  5. Santiago Perez Lloret
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Corresponding author

Correspondence to Veit Mylius.

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No sources of funding were received for the preparation of this article.

Conflict of interest

Veit Mylius consulted for Abbvie, and received research grants from Zambon and Mundipharma. He further received support from Boston Scientific, Licher MT, Abbvie, and Medtronic. Santiago Perez-Lloret received honoraria from IPMDS and consulted for ELEA laboratories and Inmunova Laboratories. Jens Carsten Möller, Stephan Bohlhalter, and Daniel Ciampi de Andrade have no conflicts of interest that are directly relevant to the content of this article.

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VM drafted the first version, DCDA and SPL drafted parts of the manuscript. JCM and SB corrected and improved the first version. All authors improved the subsequent versions and gave their final consent.

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Mylius, V., Möller, J.C., Bohlhalter, S. et al. Diagnosis and Management of Pain in Parkinson's Disease: A New Approach. Drugs Aging 38, 559–577 (2021). https://doi.org/10.1007/s40266-021-00867-1

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