Epidemiology and clinical phenomenology for Parkinson's disease with pain and fatigue

doi:10.1016/S1353-8020(11)70068-2

Parkinsonism & Related Disorders

Volume 18, Supplement 1, January 2012, Pages S222-S225

https://doi.org/10.1016/S1353-8020(11)70068-2 Get rights and content

Summary

We conducted a cross-sectional analysis with 901 Parkinson's disease (PD) patients in China to understand the epidemiological characteristics of PD pain among Chinese patients. In addition, we searched PubMed and the China Hospital Knowledge Database for epidemiological studies of pain and fatigue among PD patients from 1999 to 2011 to understand the prevalence of these symptoms around the world and associated clinical features. The 901 PD cases were recruited from 42 university affiliated hospitals randomly selected from seven provincial capitals across four economic regions of China. We documented motor and non-motor symptoms via clinical examinations and questionnaire surveys. Using logistic regression models, we evaluated factors that were associated with PD pain among these Chinese patients. Of the 901 Chinese patients, 269 (29.9%) had PD-related pain. After adjusting for confounders, only dyskinesias (OR = 2.66) and depression (OR = 2.88) were independently associated with PD pain. The literature search identified a total of 16 eligible studies on PD-pain and 19 on PD fatigue with various tools for symptom assessment. The data suggest a crude prevalence of 33.7% for PD pain in Asia and 79.4% in Northern Europe; the prevalence for PD fatigue was 35.4% in Northern Europe and 59.1% in Western Europe. Interestingly, Northern-European PD patients reported the highest prevalence of pain, but the lowest prevalence of fatigue. These studies suggest that motor complications and depression are likely key predictors for PD pain, while disease severity, depression and sleep disturbance are associated with PD fatigue. More studies with standardized methods would be needed to better understand the prevalence of PD pain and fatigue across various regions of the world.

References (29)

MA Lee et al.
A survey of pain in idiopathic Parkinson's disease
J Pain Symptom Manage
(2006)
AG Beiske et al.
Pain in Parkinson's disease: Prevalence and characteristics
Pain
(2009)
HA Hanagasi et al.
Pain is common in Parkinson's disease
Clin Neurol Neurosurg
(2011)
BH Quittenbaum et al.
Quality of life and pain in Parkinson's disease: a controlled cross-sectional study
Parkinsonism Relat Disord
(2004)
U Ehrt et al.
Pain and its relationship to depression in Parkinson disease
Am J Geriatr Psychiatry
(2009)
E Havlikova et al.
Fatigue in Parkinson's disease is not related to excessive sleepiness or quality of sleep
J Neurol Sci
(2008)
AJ Stoessl
Functional imaging studies of non-motoric manifestations of Parkinson's Disease
Parkinsonism Relat Disord
(2009)
KR Chaudhuri et al.
International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study
Mov Disord
(2006)
M Tinazzi et al.
Pain and motor complications in Parkinson's disease
J Neurol Neurosurg Psychiatry
(2006)
D Broetz et al.
Radicular and nonradicular back pain in Parkinson's disease: a controlled study
Mov Disord
(2007)

SM Cheon et al.

Non-motor off symptoms in Parkinson's disease

J Korean Med Sci

(2009)

B Ford

Pain in Parkinson's disease

Mov Disord

(2010)

D Santos-Garía et al.

Pain in Parkinson's disease: prevalence, characteristics, associated factors, and relation with other non motor symptoms, quality of life, autonomy, and caregiver burden

Rev Neurol

(2011)

L Nègre-Pagès et al.

Chronic pain in Parkinson's disease: the cross-sectional French DoPaMiP survey

Mov Disord

(2008)

Cited by (20)

Pain and dyskinesia in Parkinson's disease may share common pathophysiological mechanisms – An fMRI study
2020, Journal of the Neurological Sciences
Citation Excerpt :
Psychophysical methods with mechanical and thermal stimulation allow the identification of phenomena such as hyperalgesia and allodynia, which indicate that the pain system has undergone sensitization in a pro-nociceptive manner while functional imaging can objectively demonstrate increased neuronal activity in the central nervous system in association with these psychophysical findings. The presence of LID is an independent predictor for other non-motor symptoms, such as compulsive behaviors and pain [10], raising the possibility that these symptoms may share similar mechanisms. Specifically, compulsive drug taking is linked to sensitization of the nucleus accumbens on PET scans in dyskinetic patients, demonstrating that levodopa induced plastic changes do indeed affect non-motor pathways [11].
Parkinson's disease (PD) patients develop levodopa induced dyskinesia with disease progression from sensitization of central pathways. Pain pathways are also impacted with suggestions dyskinetic patients may process pain differently.
Establish if centrally sensitized nociceptive pathways are altered and dopaminergically driven in dyskinetic patients.
Clinical characteristics, affect, pain thresholds and sensitivity to pressure stimulation in the ON and OFF medication states as well as distribution of pain related activation of cortical regions on BOLD fMRI were assessed and compared between groups of patients suffering from dyskinesia and not.
Dyskinetic PD participants experienced increased pressure pain sensitivity. This was associated with increased pressure induced pain>innocuous BOLD activity in areas associated with encoding pain intensity, pain spatial orientation, descending pain mediation, sensorimotor integration, and motor control. Levodopa reduced pressure pain ratings and improved negative affect, though did not impact BOLD activity differently between the groups.
Dyskinetic PD patients experience increased pain sensitivity and centrally sensitized nociceptive pathways resembling levodopa induced sensitization though this is not directly influenced by dopamine.
Low back pain in Parkinson's disease: A cross-sectional study of its prevalence, and implications on functional capacity and quality of life
2020, Clinical Neurology and Neurosurgery
Citation Excerpt :
However, there was no difference for sociodemographic characteristics. These results are in line with other studies [2–5,8–13,28,29]. For patients with pain in different parts of the body, except LBP, the painful symptoms started after PD diagnosis.
The aim of this study was to estimate the prevalence of low back pain (LBP) in patients with Parkinson’s disease (PD) and its impact on functional capacity and quality of life.
Patients with idiopathic PD answered a questionnaire and were submitted to a clinical and functional assessment. Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr Scale, Beck Depression Inventory (BDI), McGill Pain Questionnaire (McGill), Roland Morris Disability Questionnaire (RMDQ), 39-item Parkinson’s Disease Questionnaire (PDQ-39) were used. In addition, the ability to contract transversus abdominis (TrA) was assessed.
One hundred and fifteen patients answered the questionnaire, and 95 (82.6 %) reported painful symptoms. Of these, 67 (58.3 %) had chronic LBP, and approximately 40 % patients reported its onset before diagnosis of PD. Higher scores in pain intensity, depressive symptoms and UPDRS II and III, more advanced stages of PD, and absence of TrA contraction determined poor functional limitation induced by LBP. However, pain intensity (McGill), severity of PD symptoms (UPDRS III) and absence of TrA contraction were identified as predictive factors for functional limitation and explained 66.1 % of the variance in the RMDQ. Pain intensity and LBP-related disability caused negative impact on the quality of life.
LBP is common in patients with PD and it causes disability and poor quality of life. Pain intensity, UPDRS III and absence of TrA contraction were the most significant predictive factors for disability assessed by the RMDQ.
Fatigue in Parkinson's Disease
2017, International Review of Neurobiology
Citation Excerpt :
Notably, fatigue may be seen as a premotor symptom, and a recent study found that fatigue reported by persons without a neurologic diagnosis in a primary care setting had a relative risk of 1.56 of developing PD during the next 5 years (Schrag, Horsfall, Walters, Noyce, & Petersen, 2015). Variability in prevalence estimates between studies may result from differences in how fatigue was defined, study methodology, and the populations investigated with some evidence suggesting that there may be geographic, cultural, or societal influences on the experience and reporting of fatigue (Wen et al., 2012). Other factors which may influence fatigue prevalence include gender (more likely in women), disease severity, and presence of depression or sleep disorders (Stocchi et al., 2014).
Fatigue is a common symptom in Parkinson's disease (PD), affecting approximately half of all patients. Fatigue is a significant contributor to reduction in quality of life and is a leading cause of disability. Despite the clear impact of fatigue on persons living with PD, research progress has been slow in this area in terms of uncovering the mechanisms of fatigue and there are currently no evidence-based treatments. Although fatigue is often viewed as a subjective and nonspecific symptom which cannot be studied rigorously, there is an emerging science of fatigue which is based on a careful and precise taxonomy of the construct of fatigue. In this chapter we will review advances in our conceptualization of fatigue, including providing definitions useful for both research and clinical care. We will then provide an overview for an approach to the assessment and management of persons with PD who complain of problematic fatigue. We will conclude by reviewing methods for clinical research, including outcome measures for clinical trials, findings from recent mechanistic studies, and suggestions for future research.
Associations Between Neurotransmitter Genes and Fatigue and Energy Levels in Women After Breast Cancer Surgery
2017, Journal of Pain and Symptom Management
Citation Excerpt :
These results support our findings of an association between this SNP and increased fatigue because similar to the aforementioned fatigue syndromes, PD is associated with increased NO levels.112 In addition, fatigue is a common symptom associated with PD113 and may share similar susceptibility gene polymorphisms. A different SNP in the NOS1 gene was associated with energy levels.
Fatigue is a common problem in oncology patients. Less is known about decrements in energy levels and the mechanisms that underlie both fatigue and energy.
In patients with breast cancer, variations in neurotransmitter genes between lower and higher fatigue latent classes and between the higher and lower energy latent classes were evaluated.
Patients completed assessments before and monthly for six months after surgery. Growth mixture modeling was used to identify distinct latent classes for fatigue severity and energy levels. Thirty candidate genes involved in various aspects of neurotransmission were evaluated.
Eleven single-nucleotide polymorphisms or haplotypes (i.e., ADRB2 rs1042718, BDNF rs6265, COMT rs9332377, CYP3A4 rs4646437, GALR1 rs949060, GCH1 rs3783642, NOS1 rs9658498, NOS1 rs2293052, NPY1R Haplotype A04, SLC6A2 rs17841327, and 5HTTLPR + rs25531 in SLC6A4) were associated with latent class membership for fatigue. Seven single-nucleotide polymorphisms or haplotypes (i.e., NOS1 rs471871, SLC6A1 rs2675163, SLC6A1 Haplotype D01, SLC6A2 rs36027, SLC6A3 rs37022, SLC6A4 rs2020942, and TAC1 rs2072100) were associated with latent class membership for energy. Three of 13 genes (i.e., NOS1, SLC6A2, and SLC6A4) were associated with latent class membership for both fatigue and energy.
Molecular findings support the hypothesis that fatigue and energy are distinct, yet related symptoms. Results suggest that a large number of neurotransmitters play a role in the development and maintenance of fatigue and energy levels in breast cancer patients.
Parkinson's disease-associated fatigue: Emerging new therapeutic options
2014, Journal of Pain and Symptom Management
Clinical non-motor phenotyping of black and Asian minority ethnic compared to white individuals with Parkinson's disease living in the United Kingdom
2021, Journal of Parkinson's Disease

View all citing articles on Scopus

View full text

Epidemiology and clinical phenomenology for Parkinson's disease with pain and fatigue

Summary

J Pain Symptom Manage

Pain

Clin Neurol Neurosurg

Parkinsonism Relat Disord

Am J Geriatr Psychiatry

J Neurol Sci

Parkinsonism Relat Disord

International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study

Mov Disord

Pain and motor complications in Parkinson's disease

J Neurol Neurosurg Psychiatry

Radicular and nonradicular back pain in Parkinson's disease: a controlled study

Mov Disord

Non-motor off symptoms in Parkinson's disease

J Korean Med Sci

Pain in Parkinson's disease

Mov Disord

Pain in Parkinson's disease: prevalence, characteristics, associated factors, and relation with other non motor symptoms, quality of life, autonomy, and caregiver burden

Rev Neurol

Chronic pain in Parkinson's disease: the cross-sectional French DoPaMiP survey

Mov Disord