CNS Drugs

, Volume 26, Issue 11, pp 937–948

Management of Pain in Parkinson’s Disease

Therapy in Practice

Abstract

Pain is a common symptom in Parkinson’s disease (PD) and accounts for substantial morbidity in up to 80 % of patients. Despite contributing to disease-related discomfort and disability, pain in PD frequently goes underacknowledged and undertreated in clinical practice. Although the exact underlying neurophysiology is unclear, there is increasing understanding of the role of the basal ganglia in somatosensory processing, as well as involvement of additional brainstem structures and non-dopaminergic pathways; appreciation of these mechanisms has implications for treatment strategies. Categorizing painful symptoms based on their clinical description into musculoskeletal, dystonic, radicular-peripheral neuropathic and central pain categories provides a useful framework for management. Importantly, these symptoms should be evaluated in relation to motor symptoms and dopaminergic therapy. A multi-disciplinary approach is recommended as follows: physical therapy, liaison with pain management and consultations to rheumatological, orthopaedic and neurosurgical services should be considered.

References

  1. 1.
    Huse DM, Schulman K, Orsini L, et al. Burden of illness in Parkinson’s disease. Mov Disord. 2005;20(11):1449–54.PubMedCrossRefGoogle Scholar
  2. 2.
    Politis M, Wu K, Molloy S, et al. Parkinson’s disease symptoms: the patient’s perspective. Mov Disord. 2010;25(11):1646–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Witjas T, Kaphan E, Azulay JP, et al. Nonmotor fluctuations in Parkinson’s disease: frequent and disabling. Neurology. 2002;59(3):408–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Parkinson J. An essay on the shaking palsy. London: Whittingham and Rowland; 1817.Google Scholar
  5. 5.
    Gowers WR. A manual of disease of the nervous system. Philadelphia: Blakiston; 1888.Google Scholar
  6. 6.
    Charcot JM. Lectures on diseases of the nervous system. London: The New Sydenham Society; 1877.Google Scholar
  7. 7.
    Chaudhuri KR, Healy DG, Schapira AH. Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol. 2006;5(3):235–45.PubMedCrossRefGoogle Scholar
  8. 8.
    Beiske AG, Loge JH, Ronningen A, et al. Pain in Parkinson’s disease: prevalence and characteristics. Pain. 2009;141(1–2):173–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Santos-Garcia D, Abella-Corral J, Aneiros-Diaz A, et al. Pain in Parkinson’s disease: prevalence, characteristics, associated factors, and relation with other non motor symptoms, quality of life, autonomy, and caregiver burden (in Spanish). Rev Neurol. 2011;52(7):385–93.PubMedGoogle Scholar
  10. 10.
    O’Sullivan SS, Williams DR, Gallagher DA, et al. Nonmotor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord. 2008;23(1):101–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Perrotta A, Sandrini G, Serrao M, et al. Facilitated temporal summation of pain at spinal level in Parkinson’s disease. Mov Disord. 2011;26(3):442–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Dauvilliers Y. Insomnia in patients with neurodegenerative conditions. Sleep Med. 2007;8(Suppl. 4):S27–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Ehrt U, Larsen JP, Aarsland D. Pain and its relationship to depression in Parkinson disease. Am J Geriatr Psychiatry. 2009;17(4):269–75.PubMedCrossRefGoogle Scholar
  14. 14.
    Roh JH, Kim BJ, Jang JH, et al. The relationship of pain and health-related quality of life in Korean patients with Parkinson’s disease. Acta Neurol Scand. 2009;119(6):397–403.PubMedCrossRefGoogle Scholar
  15. 15.
    Goetz CG, Tanner CM, Levy M, et al. Pain in Parkinson’s disease. Mov Disord. 1986;1(1):45–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Winter Y, von Campenhausen S, Arend M, et al. Health-related quality of life and its determinants in Parkinson’s disease: results of an Italian cohort study. Parkinsonism Relat Disord. 2011;17(4):265–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Rahman S, Griffin HJ, Quinn NP, et al. Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord. 2008;23(10):1428–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Quittenbaum BH, Grahn B. Quality of life and pain in Parkinson’s disease: a controlled cross-sectional study. Parkinsonism Relat Disord. 2004;10(3):129–36.PubMedCrossRefGoogle Scholar
  19. 19.
    Lee MA, Walker RW, Hildreth TJ, et al. A survey of pain in idiopathic Parkinson’s disease. J Pain Symptom Manage. 2006;32(5):462–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Chaudhuri KR, Prieto-Jurcynska C, Naidu Y, et al. The nondeclaration of nonmotor symptoms of Parkinson’s disease to health care professionals: an international study using the nonmotor symptoms questionnaire. Mov Disord. 2010;25(6):704–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Goy ER, Carter J, Ganzini L. Neurologic disease at the end of life: caregiver descriptions of Parkinson disease and amyotrophic lateral sclerosis. J Palliat Med. 2008;11(4):548–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Marsala S, Tinazzi M, Vitaliani R, et al. Spontaneous pain, pain threshold, and pain tolerance in Parkinson’s disease. J Neurol. 2011;258(4):627–33.CrossRefGoogle Scholar
  23. 23.
    Tinazzi M, Del Vesco C, Fincati E, et al. Pain and motor complications in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006;77(7):822–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Chudler EH, Dong WK. The role of the basal ganglia in nociception and pain. Pain. 1995;60(1):3–38.PubMedCrossRefGoogle Scholar
  25. 25.
    Barnes CD, Fung SJ, Adams WL. Inhibitory effects of substantia nigra on impulse transmission from nociceptors. Pain. 1979;6(2):207–15.PubMedCrossRefGoogle Scholar
  26. 26.
    Burkey AR, Carstens E, Jasmin L. Dopamine reuptake inhibition in the rostral agranular insular cortex produces antinociception. J Neurosci. 1999;19(10):4169–79.PubMedGoogle Scholar
  27. 27.
    Honey CR, Stoessl AJ, Tsui JK, et al. Unilateral pallidotomy for reduction of parkinsonian pain. J Neurosurg. 1999;91(2):198–201.PubMedCrossRefGoogle Scholar
  28. 28.
    Loher TJ, Burgunder JM, Weber S, et al. Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2002;73(4):395–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Scherder E, Wolters E, Polman C, et al. Pain in Parkinson’s disease and multiple sclerosis: its relation to the medial and lateral pain systems. Neurosci Biobehav Rev. 2005;29(7):1047–56.PubMedCrossRefGoogle Scholar
  30. 30.
    Braak H, Del Tredici K, Rub U, et al. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. 2003;24(2):197–211.PubMedCrossRefGoogle Scholar
  31. 31.
    Schestatsky P, Kumru H, Valls-Sole J, et al. Neurophysiologic study of central pain in patients with Parkinson disease. Neurology. 2007;69(23):2162–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Gerdelat-Mas A, Simonetta-Moreau M, Thalamas C, et al. Levodopa raises objective pain threshold in Parkinson’s disease: a RIII reflex study. J Neurol Neurosurg Psychiatry. 2007;78(10):1140–2.PubMedCrossRefGoogle Scholar
  33. 33.
    Brefel-Courbon C, Payoux P, Thalamas C, et al. Effect of levodopa on pain threshold in Parkinson’s disease: a clinical and positron emission tomography study. Mov Disord. 2005;20(12):1557–63.PubMedCrossRefGoogle Scholar
  34. 34.
    Mylius V, Engau I, Teepker M, et al. Pain sensitivity and descending inhibition of pain in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2009;80(1):24–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Slaoui T, Mas-Gerdelat A, Ory-Magne F, et al. Levodopa modifies pain thresholds in Parkinson’s disease patients (in French). Rev Neurol (Paris). 2007;163(1):66–71.CrossRefGoogle Scholar
  36. 36.
    Serrao M, Parisi L, Valente G, et al. L-Dopa decreases cutaneous nociceptive inhibition of motor activity in Parkinson’s disease. Acta Neurol Scand. 2002;105(3):196–201.PubMedCrossRefGoogle Scholar
  37. 37.
    Braak H, Sastre M, Bohl JR, et al. Parkinson’s disease: lesions in dorsal horn layer I, involvement of parasympathetic and sympathetic pre- and postganglionic neurons. Acta Neuropathol. 2007;113(4):421–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Nolano M, Provitera V, Estraneo A, et al. Sensory deficit in Parkinson’s disease: evidence of a cutaneous denervation. Brain. 2008;131(Pt 7):1903–11.PubMedCrossRefGoogle Scholar
  39. 39.
    Wood PB. Role of central dopamine in pain and analgesia. Exp Rev Neurother. 2008;8(5):781–97.CrossRefGoogle Scholar
  40. 40.
    Juri C, Rodriguez-Oroz M, Obeso JA. The pathophysiological basis of sensory disturbances in Parkinson’s disease. J Neurol Sci. 2010;289(1–2):60–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Djaldetti R, Shifrin A, Rogowski Z, et al. Quantitative measurement of pain sensation in patients with Parkinson disease. Neurology. 2004;62(12):2171–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Dellapina E, Gerdelat-Mas A, Ory-Magne F, et al. Apomorphine effect on pain threshold in Parkinson’s disease: a clinical and positron emission tomography study. Mov Disord. 2011;26(1):153–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Barone P. Neurotransmission in Parkinson’s disease: beyond dopamine. Eur J Neurol. 2010;17(3):364–76.PubMedCrossRefGoogle Scholar
  44. 44.
    Defazio G, Berardelli A, Fabbrini G, et al. Pain as a nonmotor symptom of Parkinson disease: evidence from a case-control study. Arch Neurol. 2008;65(9):1191–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Negre-Pages L, Regragui W, Bouhassira D, et al. Chronic pain in Parkinson’s disease: the cross-sectional French DoPaMiP survey. Mov Disord. 2008;23(10):1361–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Letro GH, Quagliato EM, Viana MA. Pain in Parkinson’s disease. Arq Neuropsiquiatr. 2009;67(3A):591–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Mott S, Kenrick M, Dixon M, et al. Pain as a sequela of Parkinson disease. Aust Fam Physician. 2004;33(8):663–4.PubMedGoogle Scholar
  48. 48.
    Ford B. Pain in Parkinson’s disease. Clin Neurosci. 1998;5(2):63–72.PubMedGoogle Scholar
  49. 49.
    Hanagasi HA, Akat S, Gurvit H, et al. Pain is common in Parkinson’s disease. Clin Neurol Neurosurg. 2011;113(1):11–3.PubMedCrossRefGoogle Scholar
  50. 50.
    Duvoisin RC, Marsden CD. Note on the scoliosis of Parkinsonism. J Neurol Neurosurg Psychiatry. 1975;38(8):787–93.PubMedCrossRefGoogle Scholar
  51. 51.
    Bissonnette B. Pseudorheumatoid deformity of the feet associated with parkinsonism. J Rheumatol. 1986;13(4):825–6.PubMedGoogle Scholar
  52. 52.
    Broetz D, Eichner M, Gasser T, et al. Radicular and nonradicular back pain in Parkinson’s disease: a controlled study. Mov Disord. 2007;22(6):853–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Schnitzer TJ. Update on guidelines for the treatment of chronic musculoskeletal pain. Clin Rheumatol. 2006;25(Suppl. 1):S22–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Ford B. Pain in Parkinson’s disease. Mov Disord. 2010;25(Suppl. 1):S98–103.PubMedCrossRefGoogle Scholar
  55. 55.
    Madden MB, Hall DA. Shoulder pain in Parkinson’s disease: a case-control study. Mov Disord. 2010;25(8):1105–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Yucel A, Kusbeci OY. Magnetic resonance imaging findings of shoulders in Parkinson’s disease. Mov Disord. 2010;25(15):2524–30.PubMedCrossRefGoogle Scholar
  57. 57.
    Kryzak TJ, Sperling JW, Schleck CD, et al. Total shoulder arthroplasty in patients with Parkinson’s disease. J Shoulder Elbow Surg. 2009;18(1):96–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Etchepare F, Rozenberg S, Mirault T, et al. Back problems in Parkinson’s disease: an underestimated problem. Joint Bone Spine. 2006;73(3):298–302.PubMedCrossRefGoogle Scholar
  59. 59.
    Koller H, Acosta F, Zenner J, et al. Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine. Eur Spine J. 2010;19(10):1785–94.PubMedCrossRefGoogle Scholar
  60. 60.
    Babat LB, McLain RF, Bingaman W, et al. Spinal surgery in patients with Parkinson’s disease: construct failure and progressive deformity. Spine. 2004;29(18):2006–12.PubMedCrossRefGoogle Scholar
  61. 61.
    Moon SH, Lee HM, Chun HJ, et al. Surgical outcome of lumbar fusion surgery in patients with Parkinson disease. J Spinal Disord Tech (Epub 2011 Jun 16).Google Scholar
  62. 62.
    Margraf NG, Wrede A, Rohr A, et al. Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord. 2010;25(5):542–51.PubMedCrossRefGoogle Scholar
  63. 63.
    Azher SN, Jankovic J. Camptocormia: pathogenesis, classification, and response to therapy. Neurology. 2005;65(3):355–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Finsterer J, Strobl W. Presentation, etiology, diagnosis, and management of camptocormia. Eur Neurol. 2010;64(1):1–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Tolosa E, Compta Y. Dystonia in Parkinson’s disease. J Neurol. 2006;253 Suppl. 7:VII7–13.Google Scholar
  66. 66.
    Jankovic J, Albanese A, Hallett M. Unique properties of botulinum toxins. Toxicon. 2009;54(5):675.PubMedCrossRefGoogle Scholar
  67. 67.
    Sako W, Nishio M, Maruo T, et al. Subthalamic nucleus deep brain stimulation for camptocormia associated with Parkinson’s disease. Mov Disord. 2009;24(7):1076–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Hellmann MA, Djaldetti R, Israel Z, et al. Effect of deep brain subthalamic stimulation on camptocormia and postural abnormalities in idiopathic Parkinson’s disease. Mov Disord. 2006;21(11):2008–10.PubMedCrossRefGoogle Scholar
  69. 69.
    Koller WC. Sensory symptoms in Parkinson’s disease. Neurology. 1984;34(7):957–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Macaulay W, Geller JA, Brown AR, et al. Total knee arthroplasty and Parkinson disease: enhancing outcomes and avoiding complications. J Am Acad Orthop Surg. 2010;18(11):687–94.PubMedGoogle Scholar
  71. 71.
    Ashour R, Tintner R, Jankovic J. Striatal deformities of the hand and foot in Parkinson’s disease. Lancet Neurol. 2005;4(7):423–31.PubMedCrossRefGoogle Scholar
  72. 72.
    Ashour R, Jankovic J. Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord. 2006;21(11):1856–63.PubMedCrossRefGoogle Scholar
  73. 73.
    Deonna T, Ferreira A. Idiopathic fluctuating dystonia: a case of foot dystonia and writer’s cramp responsive to l-dopa. Dev Med Child Neurol. 1985;27(6):819–21.PubMedCrossRefGoogle Scholar
  74. 74.
    Jankovic J. Disease-oriented approach to botulinum toxin use. Toxicon. 2009;54(5):614–23.PubMedCrossRefGoogle Scholar
  75. 75.
    Moore TJ, Evans W, Murray D. Operative management of foot and ankle equinovarus associated with focal dystonia. Foot Ankle Int. 1998;19(4):229–31.PubMedCrossRefGoogle Scholar
  76. 76.
    Quinn NP. Classification of fluctuations in patients with Parkinson’s disease. Neurology. 1998;51(2 Suppl. 2):S25–9.Google Scholar
  77. 77.
    Kidron D, Melamed E. Forms of dystonia in patients with Parkinson’s disease. Neurology. 1987;37(6):1009–11.PubMedCrossRefGoogle Scholar
  78. 78.
    Juncos JL, Fabbrini G, Mouradian MM, et al. Controlled release levodopa-carbidopa (CR-5) in the management of parkinsonian motor fluctuations. Arch Neurol. 1987;44(10):1010–2.PubMedCrossRefGoogle Scholar
  79. 79.
    Lera G, Vaamonde J, Rodriguez M, et al. Cabergoline in Parkinson’s disease: long-term follow-up. Neurology. 1993;43(12):2587–90.PubMedCrossRefGoogle Scholar
  80. 80.
    Pastor P, Tolosa E. Cabergoline in the treatment of Parkinson’s disease (in Spanish). Neurologia. 2003;18(4):202–9.PubMedGoogle Scholar
  81. 81.
    Juri C, Rodriguez-Oroz MC, Burguera JA, et al. Pain and dyskinesia in Parkinson’s disease. Mov Disord. 2010;25(1):130–2.PubMedCrossRefGoogle Scholar
  82. 82.
    Karlsborg M, Korbo L, Regeur L, et al. Duodopa pump treatment in patients with advanced Parkinson’s disease. Dan Med Bull. 2010;57(6):A4155.PubMedGoogle Scholar
  83. 83.
    Lees AJ. Dopamine agonists in Parkinson’s disease: a look at apomorphine. Fundam Clin Pharmacol. 1993;7(3–4):121–8.PubMedCrossRefGoogle Scholar
  84. 84.
    Sanford M, Scott LJ. Rotigotine transdermal patch: a review of its use in the treatment of Parkinson’s disease. CNS Drugs. 2011;25(8):699–719.PubMedCrossRefGoogle Scholar
  85. 85.
    Stocchi F, Ruggieri S, Antonini A, et al. Subcutaneous lisuride infusion in Parkinson’s disease: clinical results using different modes of administration. J Neural Transm Suppl. 1988;27:27–33.PubMedGoogle Scholar
  86. 86.
    Melamed E. Early-morning dystonia: a late side effect of long-term levodopa therapy in Parkinson’s disease. Arch Neurol. 1979;36(5):308–10.PubMedCrossRefGoogle Scholar
  87. 87.
    Poewe WH, Lees AJ, Stern GM. Dystonia in Parkinson’s disease: clinical and pharmacological features. Ann Neurol. 1988;23(1):73–8.PubMedCrossRefGoogle Scholar
  88. 88.
    Simuni T, Lyons KE, Pahwa R, et al. Treatment of early Parkinson’s disease: part 2. Eur Neurol. 2009;61(4):206–15.PubMedCrossRefGoogle Scholar
  89. 89.
    Cordivari C, Misra VP, Catania S, et al. Treatment of dystonic clenched fist with botulinum toxin. Mov Disord. 2001;16(5):907–13.PubMedCrossRefGoogle Scholar
  90. 90.
    Pacchetti C, Albani G, Martignoni E, et al. “Off” painful dystonia in Parkinson’s disease treated with botulinum toxin. Mov Disord. 1995;10(3):333–6.PubMedCrossRefGoogle Scholar
  91. 91.
    Limousin P, Krack P, Pollak P, et al. Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med. 1998;339(16):1105–11.PubMedCrossRefGoogle Scholar
  92. 92.
    Ford B, Greene P, Louis ED, et al. Use of intrathecal baclofen in the treatment of patients with dystonia. Arch Neurol. 1996;53(12):1241–6.PubMedCrossRefGoogle Scholar
  93. 93.
    Kodama M, Kasahara T, Hyodo M, et al. Effect of low-frequency repetitive transcranial magnetic stimulation combined with physical therapy on L-dopa-induced painful off-period dystonia in Parkinson’s disease. Am J Phys Med Rehabil. 2011;90(2):150–5.PubMedCrossRefGoogle Scholar
  94. 94.
    Fabbrini G, Brotchie JM, Grandas F, et al. Levodopa-induced dyskinesias. Mov Disord. 2007;22(10):1379–89. (quiz 523).PubMedCrossRefGoogle Scholar
  95. 95.
    Thomas A, Iacono D, Luciano AL, et al. Duration of amantadine benefit on dyskinesia of severe Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2004;75(1):141–3.PubMedGoogle Scholar
  96. 96.
    Metman LV, Del Dotto P, LePoole K, et al. Amantadine for levodopa-induced dyskinesias: a 1-year follow-up study. Arch Neurol. 1999;56(11):1383–6.PubMedCrossRefGoogle Scholar
  97. 97.
    Durif F, Debilly B, Galitzky M, et al. Clozapine improves dyskinesias in Parkinson disease: a double-blind, placebo-controlled study. Neurology. 2004;62(3):381–8.PubMedCrossRefGoogle Scholar
  98. 98.
    Anderson VC, Burchiel KJ, Hogarth P, et al. Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease. Arch Neurol. 2005;62(4):554–60.PubMedCrossRefGoogle Scholar
  99. 99.
    Preston DN, Grimes JD. Radial compression neuropathy in advanced Parkinson’s disease. Arch Neurol. 1985;42(7):695–6.PubMedCrossRefGoogle Scholar
  100. 100.
    Kurlan R, Baker P, Miller C, et al. Severe compression neuropathy following sudden onset of parkinsonian immobility. Arch Neurol. 1985;42(7):720.PubMedCrossRefGoogle Scholar
  101. 101.
    Rajabally YA, Martey J. Neuropathy in Parkinson disease: prevalence and determinants. Neurology. 2011;77(22):1947–50.PubMedCrossRefGoogle Scholar
  102. 102.
    Toth C, Breithaupt K, Ge S, et al. Levodopa, methylmalonic acid, and neuropathy in idiopathic Parkinson disease. Ann Neurol. 2010;68(1):28–36.PubMedCrossRefGoogle Scholar
  103. 103.
    O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med. 2009;122(10 Suppl):S22–32.PubMedCrossRefGoogle Scholar
  104. 104.
    Snider SR, Fahn S, Isgreen WP, et al. Primary sensory symptoms in parkinsonism. Neurology. 1976;26(5):423–9.PubMedCrossRefGoogle Scholar
  105. 105.
    Quinn NP, Koller WC, Lang AE, et al. Painful Parkinson’s disease. Lancet. 1986;1(8494):1366–9.PubMedCrossRefGoogle Scholar
  106. 106.
    Ford B, Louis ED, Greene P, et al. Oral and genital pain syndromes in Parkinson’s disease. Mov Disord. 1996;11(4):421–6.PubMedCrossRefGoogle Scholar
  107. 107.
    Bayulkem K, Lopez G. Nonmotor fluctuations in Parkinson’s disease: clinical spectrum and classification. J Neurol Sci. 2010;289(1–2):89–92.PubMedCrossRefGoogle Scholar
  108. 108.
    Raudino F. Non motor off in Parkinson’s disease. Acta Neurol Scand. 2001;104(5):312–5.PubMedCrossRefGoogle Scholar
  109. 109.
    Witjas T, Kaphan E, Regis J, et al. Effects of chronic subthalamic stimulation on nonmotor fluctuations in Parkinson’s disease. Mov Disord. 2007;22(12):1729–34.PubMedCrossRefGoogle Scholar
  110. 110.
    Maruo T, Saitoh Y, Hosomi K, et al. Deep brain stimulation of the subthalamic nucleus improves temperature sensation in patients with Parkinson’s disease. Pain. 2011;152(4):860–5.PubMedCrossRefGoogle Scholar
  111. 111.
    Gierthmuhlen J, Arning P, Binder A, et al. Influence of deep brain stimulation and levodopa on sensory signs in Parkinson’s disease. Mov Disord. 2010;25(9):1195–202.PubMedCrossRefGoogle Scholar
  112. 112.
    Goodwin VA, Richards SH, Taylor RS, et al. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord. 2008;23(5):631–40.PubMedCrossRefGoogle Scholar
  113. 113.
    Reuter I, Mehnert S, Leone P, et al. Effects of a flexibility and relaxation programme, walking, and nordic walking on Parkinson’s disease. J Aging Res. 2011;2011:232473.PubMedGoogle Scholar
  114. 114.
    Pecci C, Rivas MJ, Moretti CM, et al. Use of complementary and alternative therapies in outpatients with Parkinson’s disease in Argentina. Mov Disord. 2010;25(13):2094–8.PubMedCrossRefGoogle Scholar
  115. 115.
    Kim SR, Lee TY, Kim MS, et al. Use of complementary and alternative medicine by Korean patients with Parkinson’s disease. Clin Neurol Neurosurg. 2009;111(2):156–60.PubMedCrossRefGoogle Scholar
  116. 116.
    Tan LC, Lau PN, Jamora RD, et al. Use of complementary therapies in patients with Parkinson’s disease in Singapore. Mov Disord. 2006;21(1):86–9.PubMedCrossRefGoogle Scholar
  117. 117.
    Ferry P, Johnson M, Wallis P. Use of complementary therapies and non-prescribed medication in patients with Parkinson’s disease. Postgrad Med J. 2002;78(924):612–4.PubMedCrossRefGoogle Scholar
  118. 118.
    Rajendran PR, Thompson RE, Reich SG. The use of alternative therapies by patients with Parkinson’s disease. Neurology. 2001;57(5):790–4.PubMedCrossRefGoogle Scholar
  119. 119.
    Cristian A, Katz M, Cutrone E, et al. Evaluation of acupuncture in the treatment of Parkinson’s disease: a double-blind pilot study. Mov Disord. 2005;20(9):1185–8.PubMedCrossRefGoogle Scholar
  120. 120.
    Shulman LM, Wen X, Weiner WJ, et al. Acupuncture therapy for the symptoms of Parkinson’s disease. Mov Disord. 2002;17(4):799–802.PubMedCrossRefGoogle Scholar
  121. 121.
    Kim HJ, Paek SH, Kim JY, et al. Chronic subthalamic deep brain stimulation improves pain in Parkinson disease. J Neurol. 2008;255(12):1889–94.PubMedCrossRefGoogle Scholar
  122. 122.
    Oshima H, Katayama Y, Morishita T, et al. Subthalamic nucleus stimulation for attenuation of pain related to Parkinson disease. J Neurosurg. 2012;116(1):99–106.PubMedCrossRefGoogle Scholar
  123. 123.
    Silva EG, Viana MA, Quagliato EM. Pain in Parkinson’s disease: analysis of 50 cases in a clinic of movement disorders. Arq Neuropsiquiatr. 2008;66(1):26–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2012

Authors and Affiliations

  1. 1.Department of NeurologyColumbia UniversityNew YorkUSA
  2. 2.The Neurological Institute of New YorkNew YorkUSA

Personalised recommendations