Notes from “Pain in Parkinson’s Disease” webinar

Though this webinar was focused on Parkinson’s Disease, nearly all of the information shared applies to those within Brain Support Network.

Last Tuesday, the Parkinson’s Disease Foundation ( hosted a webinar on “Pain in Parkinson’s Disease.”  The speaker was Dr. Jori Fleisher, a movement disorder specialist with NYU Langone.

The slides from the talk are here:

You can view the recording — which includes the 45-minute formal presentation plus a great 20-minute Q&A — here:

You’ll have to register first.  Registration is free.

Brain Support Network super-volunteer Denise Dagan listened to the webinar and wrote up some highlights.  Of course you can find lots more details by viewing the slides or, better yet, by listening to the recording.  See Denise’s notes below.



Notes from Denise Dagan

Pain in PD
Parkinson’s Disease Foundation Webinar
January 10, 2017

Dr. Jori Fleisher spoke for 45 minutes + 20 minutes of Q&A on these points:

Pain is common, under-recognized, under-reported, detrimental and manageable as a non-motor symptom of Parkinson’s disease.  By detrimental, she meant pain can keep you from exercising, thereby worsening stiffness, contractures, and balance, potentially falling and resultant injury.

Early, asymmetric stiff or painful shoulder (hip or knee) is a common, often misdiagnosed presenting symptom of Parkinson’s disease.  Talk with your neurologist or movement disorder specialist before you get surgery.

There are four categories of pain.  More than one may be present in Parkinson’s disease.

1. Musculoskeletal pain is most prevalent (45-75% of patients) and involves muscle cramps, tightness (especially in the neck), paraspinal (on either side of the spine), or joint pain (distinct from arthritis in unilaterality & lack of inflammatory changes).

2. Dystonic pain (8-50% of patients) is caused by both sides of a limb’s muscles spasming simultaneously.  It can occur early in Parkinson’s disease, even as a presenting symptom, or as a complication of treatment, either as an early morning off-dystonia or at the peak of medication effectiveness, especially in the neck and face.

3. Radicular or Neuropathic pain (5-20% of patients)

* Radicular pain is caused by a pinched nerve due to a herniated disk in the spine which may be due to postural abnormalities or dystonia.  Physical therapy should be tried to remedy those postural changes brought about because of Parkinson’s disease.

* Peripheral Neuropathy refers to the bottoms of feet or fingertips and occurs more often than expected in Parkinson’s disease.  It is potentially related to dopaminergic therapy.

4. Central pain (10-12% of patients) is hard to describe, vague, constant, not localized to a specific nerve distribution.  It may have autonomic or visceral character in some Parkinson’s patients and present as reflux, labored breathing, or feeling flushed in the oral or general areas.

In communicating your experience of pain to your neurologist, consider using the OLD CARTS reference to be thorough.  Doctors can’t help at all if they don’t have specific information.  OLD CARTS stands for:

* Onset  (when did it start?)

* Location  (where does it hurt?)

* Duration  (how long does it last?)

* Character  (how does it feel?  Sharp, tired muscle, nauseating, etc.)

* Aggravating and alleviating factors  (exercising, resting, pain killers, next PD med dose, postural changes?)

* Radiation  (does it travel along the nerves from the point of origin?)

* Timing  (especially in relation to when you take your meds., mornings, after exercise or prolonged sitting)

* Severity  (completely pain free or child birth on a scale of 1-10)

Pain management in Parkinson’s disease requires attention to timing, quality of the pain, and relation to medication doses.  So, keep a diary of when you actually swallowed your medication and answer all the OLD CART questions in your diary with respect to your pain.  This should give your doctor enough information to determine how to help.

Multidisciplinary, customized approach to each patient’s pain should include:

– Physical therapy and exercise to improve mobility, prevent contractors, maintain range of motion.

– Pharmacotherapy tailored to the particular pain type(s).  May require adjusting Parkinson’s medications and/or adding anti-inflammatories, anti-depressants, anti-epileptics, or opiates, depending on the type and cause of pain.

– There are no proven benefit for medical marijuana or other alternative treatments (yet).  In fact, the effects of using marijuana include low blood pressure, dizziness, hallucinations, sleepiness, and confusion, which are similar to Parkinson’s symptoms and Parkinson’s medication side effects, so marijuana is not a recommended alternative therapy for any symptoms of Parkinson’s disease, including pain.