Background & Aims
Parkinson’s disease (PD) is a typical neurodegenerative disease characterized primarily by the degeneration of dopaminergic neurons in the substantia nigra, with pain prevalence ranging from 40 to 85% among patients with PD. In PD model rats, serotonin secretion is decreased due to damage to the nucleus raphe magnus, in addition to a decrease in pain sensitivity, suggesting an impairment of the endogenous pain modulatory system. However, it is unknown whether the endogenous pain modulatory system is associated with pain in patients with PD. The purpose of this study is to explore the relationship between pain and the endogenous pain modulatory system in patients with PD.
Methods
This cross-sectional study involved 12 patients with PD admitted to Hyogo Prefectural Rehabilitation Central Hospital. Demographic data (age, sex, PD duration, Hohen & Yahr stage [H&Y stage], and levodopa equivalent daily dose [LEDD]) were collected at admission. Pain assessments were evaluated the brief pain inventory (BPI)-pain severity, King’s Parkinson’s disease pain Scale (KPPS), pressure pain threshold (PPT), and conditioned pain modulation (CPM), a measure of the endogenous pain modulatory system. These assessments were conducted during the “on” medication phase at the first physical therapy session. PPT and CPM were evaluated at the forearm. Furthermore, we analyzed the correlation between pain outcomes and the endogenous pain modulatory system using the Spearman’s rank correlation coefficient.
Results
Demographic data were age of 73.4 ± 4.4 years, with 66.7% male patients (8 of 12), PD duration of 10.3 ± 4.3 years, H&Y stage of 3.6 ± 0.6, and LEDD of 843.7 ± 230.7. Pain assessments were BPI-pain severity of 14.7 ± 7.4 points, KPPS of 14.5 ± 5.2 points, PPT of 17.3 ± 4.6 N, and CPM of 12.8 ± 22.4 %, with 6 out of 12 patients with PD displaying low CPM levels. Notably, CPM demonstrated a significant negative correlation with H&Y stage (r = – 0.704, p < 0.05), BPI-pain severity (r = - 0.617, p < 0.05), and KPPS (r = - 0.722, p < 0.05).
Conclusions
The findings suggest a dysfunction in the endogenous pain modulatory system among patients with PD. Moreover, a higher severity of PD and more pronounced pain symptoms were associated with a lower endogenous pain modulatory system. The degeneration of brain regions implicated in the endogenous pain modulatory system, as PD progresses, may account for the high pain prevalence observed. These insights underscore the importance of considering the integrity of the endogenous pain modulatory system in managing pain among patients with PD. Further research exploring targeted interventions to enhance or stabilize this system might prove beneficial in alleviating pain symptoms in this patient population.
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Presenting Author
Hajime Maeda
Poster Authors
Hajime Maeda
Department of Rehabilitation, Hyogo Prefectural Rehabilitation Central Hospital
Lead Author
Kenichi Kimura
Department of Neurology, Hyogo Prefectural Rehabilitation Central Hospital
Lead Author
shuhei yamaguchi
Saishukan Hospital
Lead Author
Takafumi Hattori
Kobe Gakuin University
Lead Author
Satoshi Ohga
Kobe Gakuin University
Lead Author
Kazuhiro Shimo
Kobe Gakuin University
Lead Author
Takako Matsubara
Kobe Gakuin University
Lead Author
Topics
- Assessment and Diagnosis