Background & Aims

Up to 80% of people with Parkinson’s (PwP) experience chronic pain [1]. A lack of adequate treatment for this major non-motor symptom is due to equivocal knowledge regarding the underlying mechanisms for its initiation and maintenance [2]. Previous clinical studies have produced conflicting results regarding central manifestations of dysfunctionality in PwP [3-6]. Thus, the current study aimed to apply psychophysics and questionnaires to distinct cohorts of PwP to create sensory profiles that inform on the body’s natural ability to sense and modulate pain.

Methods

43 PwP with severe chronic pain and 43 PwP without severe pain were recruited along with 43 healthy controls to undergo quantitative sensory testing, temporal summation of pain, and conditioned pain modulation, whereupon psychophysics readouts were linked to the King’s Parkinson’s Pain Scale data. Personalised “sensitivity profiles” were generated and compared between groups.

Results

We observed significantly greater burden of both motor and non-motor Parkinson’s symptoms in the group of PwP with severe pain compared to those without severe pain. In regards to quantitative sensory testing, results indicate possible increased cold detection and heat pain thresholds and increased mechanical pain sensitivity in severely painful Parkinson’s compared to healthy controls, otherwise peripheral nerve fibre function was comparable between the 3 groups. Notably, when analysing proportions of CPM responders vs. non-responders in terms of Pain Tolerance Threshold, we observed significant differences: A Chi Squared test revealed a significantly greater proportion of responders vs. non-responders in the HC group compared to PwP. We observed no differences in responder proportion for Pain Detection Threshold.

Conclusions

The greatest overall burden of disease is on PwP who experience high levels of pain, highlighting the importance of considering presence of pain when conducting research on Parkinson’s and developing therapeutic approaches. Descending pain modulation may be affected by Parkinson’s, regardless of pain levels, which is potentially reflective of a noradrenergic subtype as described in current Parkinson’s literature [7].

References

1. Broen, M. P., Braaksma, M. M., Patijn, J., & Weber, W. E. (2012). Prevalence of pain in Parkinson’s disease: a systematic review using the modified QUADAS tool. Movement Disorders, 27(4), 480-484.
2. Fil, A., Cano-de-la-Cuerda, R., Muñoz-Hellín, E., Vela, L., Ramiro-González, M., & Fernández-de-Las-Peñas, C. (2013). Pain in Parkinson disease: a review of the literature. Parkinsonism & related disorders, 19(3), 285-294.
3. Djaldetti, R., Shifrin, A., Rogowski, Z., Sprecher, E., Melamed, E., & Yarnitsky, D. (2004). Quantitative measurement of pain sensation in patients with Parkinson disease. Neurology, 62(12), 2171-2175.
4. Mylius, V., Engau, I., Teepker, M., Stiasny-Kolster, K., Schepelmann, K., Oertel, W. H., … & Möller, J. C. (2009). Pain sensitivity and descending inhibition of pain in Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 80(1), 24-28.
5. ZambitoMarsala, S., Tinazzi, M., Vitaliani, R., Recchia, S., Fabris, F., Marchini, C., … & Defazio, G. (2011). Spontaneous pain, pain threshold, and pain tolerance in Parkinson’s disease. Journal of neurology, 258(4), 627-633.
6. Ferreira-Sánchez, M. R., Moreno-Verdú, M., Cano-de-la-Cuerda, R., Fernández-de-Las-Peñas, C., Güeita-Rodríguez, J., & Ortega-Santiago, R. (2020). Widespread pressure pain hyperalgesia is not related to pain in patients with Parkinson’s disease. Pain Medicine, 21(2), 232-238.
7. Ray Chaudhuri, K., Leta, V., Bannister, K., Brooks, D. J., & Svenningsson, P. (2023). The noradrenergic subtype of Parkinson disease: from animal models to clinical practice. Nature Reviews Neurology, 19(6), 333-345.

Presenting Author

Anna Fieldwalker

Poster Authors

Anna Fieldwalker

PhD

Great Ormond Street Hospital

Lead Author

kirsty bannister

King's College London

Lead Author

K Ray Chaudhuri

DSc FRCP MD

King's College Hospital, King's College London

Lead Author

Aleksandra Podlewska

PhD

King's College Hospital, King's College London

Lead Author

Katarina Rukavina

DrMed PhD

King's College Hospital, King's College London

Lead Author

Topics

  • Mechanisms: Biological-Systems (Physiology/Anatomy)