Journal of Neurology

, 255:1889

Chronic subthalamic deep brain stimulation improves pain in Parkinson disease

ORIGINAL COMMUNICATION

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.

Key words

Parkinson disease (PD) deep brain stimulation (DBS) pain motor complications subthalamic nucleus 

References

  1. 1.
    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 40:355–366PubMedCrossRefGoogle Scholar
  2. 2.
    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 42:1554–1560PubMedGoogle Scholar
  3. 3.
    Chudler EH, Dong WK (1995) The role of the basal ganglia in nociception and pain. Pain 60:3–38PubMedCrossRefGoogle Scholar
  4. 4.
    Djaldetti R, Shifrin A, Rogowski Z, Sprecher E, Melamed E, Yarnitsky D (2004) Quantitative measurement of pain sensation in patients with Parkinson disease. Neurology 62:2171–2175PubMedGoogle Scholar
  5. 5.
    Dostrovsky JO, Lozano AM (2002) Mechanisms of deep brain stimulation. Mov Disord 17(Suppl. 3):S63–S68PubMedCrossRefGoogle Scholar
  6. 6.
    Ford B (1998) Pain in Parkinson’s disease. Clin Neurosci 5:63–72PubMedCrossRefGoogle Scholar
  7. 7.
    Gao X, Zhang Y, Wu G (2000) Effects of dopaminergic agents on carrageenan hyperalgesia in rats. Eur J Pharmacol 406:53–58PubMedCrossRefGoogle Scholar
  8. 8.
    Garcia L, D’Alessandro G, Bioulac B, Hammond C (2005) High-frequency stimulation in Parkinson’s disease: more or less? Trends Neurosci 28:209–216PubMedCrossRefGoogle Scholar
  9. 9.
    Giuffrida R, Vingerhoets FJ, Bogousslavsky J, Ghika J (2005) Pain in Parkinson’s disease. Rev Neurol (Paris) 161:407–418PubMedCrossRefGoogle Scholar
  10. 10.
    Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC (1986) Pain in Parkinson’s disease. Mov Disord 1:45–49PubMedCrossRefGoogle Scholar
  11. 11.
    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 500:187–192PubMedCrossRefGoogle Scholar
  12. 12.
    Honey CR, Phil D, Stoessl AJ, Tsui JKC, Schulzer M, Calne DB (1999) Unilateral pallidotomy for reduction of parkinsonian pain. J Neurosurg 91:198–201PubMedGoogle Scholar
  13. 13.
    Josephs KA, Matsumoto JY, Ahlskog JE (2006) Benign tremulous parkinsonism. Arch Neurol 63:354–357PubMedCrossRefGoogle Scholar
  14. 14.
    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 349:1925–1934PubMedCrossRefGoogle Scholar
  15. 15.
    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 122:1133–1146PubMedCrossRefGoogle Scholar
  16. 16.
    Laitinen LV, Bergenheim AT, Hariz MI (1992) Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease. J Neurosurg 76:53–61PubMedGoogle Scholar
  17. 17.
    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 339:1105–1111PubMedCrossRefGoogle Scholar
  18. 18.
    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 73:395–399PubMedCrossRefGoogle Scholar
  19. 19.
    Magnusson JE, Fisher K (2000) The involvement of dopamine in nociception: the role of D1 and D2 receptors in the dorsolateral striatum. Brain Res 855:260–266PubMedCrossRefGoogle Scholar
  20. 20.
    Quinn NP (1998) Classification of fluctuations in patients with Parkinson’s disease. Neurology 51(Suppl 2):S25–S29PubMedGoogle Scholar
  21. 21.
    Quinn NP, Koller WC, Lang AE, Marsden CD (1986) Painful Parkinson’s disease. Lancet 1:1366–1369PubMedCrossRefGoogle Scholar
  22. 22.
    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 128:2240–2249PubMedCrossRefGoogle Scholar
  23. 23.
    Snider SR, Fahn S, Isgreen WP, Cote LJ (1976) Primary sensory symptoms in parkinsonism. Neurology 26:423–429PubMedGoogle Scholar
  24. 24.
    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 77:822–825PubMedCrossRefGoogle Scholar
  25. 25.
    Waseem S, Gwinn-Hardy K (2001) Pain in Parkinson’s disease: common yet seldom recognized symptom is treatable. Postgrad Med 110:33–40PubMedCrossRefGoogle Scholar
  26. 26.
    Witjas T, Kaphan E, Azulay JP, Blin O, Ceccaldi M, Pouget J, Poncet M, Cherif AA (2002) Nonmotor fluctuations in Parkinson’s disease. Neurology 59:408–413PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2009

Authors and Affiliations

  1. 1.Dept. of NeurologyInje University Ilsan Paik HospitalGoyang-si, Gyeonggi-doKorea
  2. 2.Dept. of Neurology, MRC and CRI, Movement Disorder CenterSeoul National University HospitalSeoulKorea
  3. 3.Dept. of Neurosurgery, MRC and CRI, Movement Disorder CenterSeoul National University HospitalSeoulKorea
  4. 4.Dept. of Neurology, College of MedicineSeoul National UniversitySeoulKorea
  5. 5.Dept. of Neurosurgery, College of MedicineSeoul National UniversitySeoulKorea

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