Parkinson's Disease, Symptoms and Pain
Symptoms generally develop slowly over years. The progression of symptoms is often a bit different from one person to another due to the diversity of the disease. People with PD may experience:
Tremor, mainly at rest and described as pill rolling tremor in hands. Other forms of tremor are possible
Bradykinesia
Limb rigidity
Gait and balance problems
The cause remains largely unknown. Although there is no cure, treatment options vary and include medications and surgery. While Parkinson’s itself is not fatal, disease complications can be serious.
The first step to living well with Parkinson’s disease is to understand the disease and the progression:
Working with your doctor and following recommended therapies are essential to successfully treat symptoms, using dopaminergic medications. People with PD have low levels of or are missing dopamine in the brain, mainly due to impairment of neurons.
People with PD first start experiencing symptoms later in the course of the disease because a significant amount of the neurons have already been lost or impaired. Scientists continue to explore ways to identify biomarkers for PD to lead to earlier diagnosis and more tailored treatments. The goal is to slow the disease process. But, at this time, therapies are focused on improving symptoms, but do not slow or halt the disease progression.
In addition to movement-related, or motor, symptoms, Parkinson’s symptoms may be unrelated to movement. In fact, contrary to common understanding, people with PD are often more impacted by their non-motor symptoms. Examples of these include: apathy, depression, constipation, sleep behavior disorders, loss of sense of smell and cognitive impairment. Treatment for this are usually dopaminergic agents, specifically, levodopa, a precursor to dopamine, given with carbidopa, which reduces peripheral conversion of levodopa to dopamine.
Pain can also be a large factor as it is common for other impairments needing to be managed such as peripheral neuralgia, other nerve damage and/or muscle spasms, bone density issues, etc. Pain affects 40% to 85% of people with Parkinson’s disease. And pain often presents before motor symptom decline. This pain in PD is classified into one of five descriptors: musculoskeletal, neuropathic, central, akathisia and dystonia. Individuals with Parkinson’s may have increased pain sensitivity, which may be a result of a reduced nociception threshold that can occur regardless of the stage of progression of the disease.