The current online version of The Journal of Neuroscience Research has an Early View paper entitled Sensory symptoms in Parkinson’s disease: Clinical features, pathophysiology and treatment (sorry, behind a paywall).
The key points:
- Nonmotor symptoms of Parkinson’s Disease (PD), often neglected, include neuropsychiatric symptoms, sleep disorders, autonomic symptoms, gastrointestinal symptoms and sensory symptoms.
- Nonmotor symptoms are often more significant than motor deficits in influencing quality of life.
- Sensory symptoms might include pain, olfactory disturbance and visual dysfunction
- Olfactory disturbances are common, usually begin before motor symptoms develop, present as deficits in odour detection, discrimination and identification and are considered as effective preclinical diagnostic markers for PD
- Severe pain is common in people with PD, with a prevalence of up to 70%
- Akathisia, a “subjective inner restlessness, producing an intolerance of remaining still or a painful impulse to move continually” may affect approximately half of people with PD and is associated with dopamine receptor blockers, dopamine depleters and SSRI medications.
- Neuropathic sensory events such as paresthesia, together with shooting, aching, burning, cramping or otherwise “bizarre and unexplained” pain may occur as a result of the disease process itself – in the literature this is discussed as “Central Neuropathic Pain”.
- Shoulder pain is particularly significant in PD:
Among widespread body areas of commonly reported pain, “frozen shoulder is the most common feature and may be the presenting sign of PD”
“A retrospective study of 82 PD patients showed that shoulder pain was a prodromal symptom in 27 cases (33%) initially diagnosed with other diseases.”
“Another case control study of 25 PD patients showed that PD patients had 21-fold greater odds of having shoulder pain compared with those without PD”
- Pain is a big problem in people with Parkinson’s Disease – often affecting quality of life more than motor symptoms
- Pain is a complex problem in people with Parkinson’s Disease – brain changes, altered sensory and nociceptive processing, dystonia and akathisia hint at possible commonalities with other complex pain states – education, motor imagery may have a role in treatment.
- If an individual in their seventh (or more) decade of life who presented with a stiff, sore shoulder mentions in passing that their coffee just doesn’t taste the same any more, it might be worth asking a few more questions.
We’re taking EP, GMI and MONIS on tour around this great southern land, click on a location for details and course flyers
Townsville: EP & GMI April 29-May 1
Canberra: MONIS at the Australian Institute of Sport May 3-4
Canberra: EP& GMI at the Australian Institute of Sport May 6-8
Adelaide: Pain, Plasticity and Rehabilitation May 14-15
Noosa: EP & GMI June 17-19
Perth: EP & GMI October 15-17
Thank you Tim for that profound clinical tip x
Thanks David. I’ve a family member who, unbeknownst to me at the time (through my ignorance of the above), was presenting the olfactory and shoulder pain symptoms years ago. I can still hear them remarking “I’ve lost my taste”. Their Parkinson’s has progressed slowly, but it is still hard to see. I’m not sure that if I’d known the above at the time whether the disease’s course could have been altered, but knowing this now I do often wonder…