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Pain in Parkinson's disease

new concepts in pathogenesis and treatment

Rukavina, Katarinaa,b,c,*; Leta, Valentinaa,b,*; Sportelli, Carolinaa,b; Buhidma, Yazeadd; Duty, Susand; Malcangio, Marziad; Ray Chaudhuri, Kallola,b

doi: 10.1097/WCO.0000000000000711
MOVEMENT DISORDERS: Edited by Per Svenningsson and Steven J. Frucht

Purpose of review In this review, we discuss the most recent evidence on mechanisms underlying pathological nociceptive processing in Parkinson's disease patients, as well as novel treatment strategies.

Recent findings In Parkinson's disease, specific neurodegenerative changes may cause alterations in nociceptive processing at multiple levels. Optimization of dopaminergic therapies should always be the first step in the management of Parkinson's disease pain. Reportedly, rotigotine transdermal patch, a monoamine oxidase type B inhibitor safinamide (as an add-on therapy to levodopa), subcutaneous apomorphine and intrajejunal levodopa infusion therapy may have a beneficial effect on pain sensations in Parkinson's disease patients. Among the nondopaminergic pharmacological therapies, prolonged-release oxycodone/naloxone and duloxetine may be effective in the treatment of chronic pain in Parkinson's disease. Botulinum toxin (BTX) injections should be considered for the treatment of dystonic Parkinson's disease pain. Deep brain stimulation (DBS) may lead to pain relief with a long-lasting effect in Parkinson's disease patients. Physiotherapy and physical activity in general are essential for Parkinson's disease patients suffering from pain.

Summary Pain in Parkinson's disease is not simply a consequence of motor complainants. The management of Parkinson's disease-related pain implicates maintenance of stable levels of dopaminergic drugs. Nondopaminergic pharmacological therapies (prolonged-release oxycodone/naloxone, duloxetine, BTX) and nonpharmacological interventions (DBS, physiotherapie) may also be beneficial in treatment of Parkinson's disease pain.

aInstitute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust

bParkinson's Foundation Centre of Excellence, King's College Hospital, London, UK

cKlinik für Gerontopsychiatrie, Asklepios Klinik Nord – Ochsenzoll, Hamburg, Germany

dInstitute of Psychiatry, Psychology & Neuroscience, Wolfson Centre for Age-Related Diseases, King's College London, London, UK

Correspondence to Katarina Rukavina, MD, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, De Crespigny Park, London SE5 8AF, UK. Tel: +44 1624338488; e-mail:

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