TY - JOUR
T1 - Pain in Parkinson disease
T2 - mechanistic substrates, main classification systems, and how to make sense out of them
AU - de Andrade, Daniel Ciampi
AU - Mylius, Veit
AU - Perez Lloret, Santiago
AU - Cury, Rubens Gisbert
AU - Bannister, Kirsty
AU - Moisset, Xavier
AU - Kubota, Gabriel Taricani
AU - Finnerup, Nanna B
AU - Bouhassira, Didier
AU - Chaudhuri, Kallol Ray
AU - Graven-Nielsen, Thomas
AU - Treede, Rolf-Detlef
N1 - The Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121). D. Ciampi de Andrade is supported by a Novo Nordisk Grant NNF21OC0072828. N. B. Finnerup’s work in neuropathic pain is
supported by the Lundbeck Foundation (R359-2020-2620).
PY - 2023/11
Y1 - 2023/11
N2 - Parkinson disease (PD) affects up to 2% of the general population older than 65 years and is a major cause of functional loss. Chronic pain is a common nonmotor symptom that affects up to 80% of patients with (Pw) PD both in prodromal phases and during the subsequent stages of the disease, negatively affecting patient's quality of life and function. Pain in PwPD is rather heterogeneous and may occur because of different mechanisms. Targeting motor symptoms by dopamine replacement or with neuromodulatory approaches may only partially control PD-related pain. Pain in general has been classified in PwPD according to the motor signs, pain dimensions, or pain subtypes. Recently, a new classification framework focusing on chronic pain was introduced to group different types of PD pains according to mechanistic descriptors: nociceptive, neuropathic, or neither nociceptive nor neuropathic. This is also in line with the International Classification of Disease-11, which acknowledges the possibility of chronic secondary musculoskeletal or nociceptive pain due to disease of the CNS. In this narrative review and opinion article, a group of basic and clinical scientists revise the mechanism of pain in PD and the challenges faced when classifying it as a stepping stone to discuss an integrative view of the current classification approaches and how clinical practice can be influenced by them. Knowledge gaps to be tackled by coming classification and therapeutic efforts are presented, as well as a potential framework to address them in a patient-oriented manner.
AB - Parkinson disease (PD) affects up to 2% of the general population older than 65 years and is a major cause of functional loss. Chronic pain is a common nonmotor symptom that affects up to 80% of patients with (Pw) PD both in prodromal phases and during the subsequent stages of the disease, negatively affecting patient's quality of life and function. Pain in PwPD is rather heterogeneous and may occur because of different mechanisms. Targeting motor symptoms by dopamine replacement or with neuromodulatory approaches may only partially control PD-related pain. Pain in general has been classified in PwPD according to the motor signs, pain dimensions, or pain subtypes. Recently, a new classification framework focusing on chronic pain was introduced to group different types of PD pains according to mechanistic descriptors: nociceptive, neuropathic, or neither nociceptive nor neuropathic. This is also in line with the International Classification of Disease-11, which acknowledges the possibility of chronic secondary musculoskeletal or nociceptive pain due to disease of the CNS. In this narrative review and opinion article, a group of basic and clinical scientists revise the mechanism of pain in PD and the challenges faced when classifying it as a stepping stone to discuss an integrative view of the current classification approaches and how clinical practice can be influenced by them. Knowledge gaps to be tackled by coming classification and therapeutic efforts are presented, as well as a potential framework to address them in a patient-oriented manner.
KW - Parkinson disease
KW - Rigidity
KW - Chronic pain
KW - Neuropathic pain
KW - Musculoskeletal pain
KW - Secondary pain
KW - Dopamine
KW - Deep brain stimulation
UR - http://www.scopus.com/inward/record.url?scp=85171482380&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000002968
DO - 10.1097/j.pain.0000000000002968
M3 - Review article
SN - 0304-3959
VL - 164
SP - 2425
EP - 2434
JO - Pain
JF - Pain
IS - 11
ER -