Objective: We aimed to explore clinical correlates and risk factors in the development of pain, alongside the relationship between pain and striatal dopaminergic dysfunction in early de novo Parkinson’s disease (PD) patients.

Background: Pain is a very common and troublesome non-motor symptom in PD. Pathophysiology underlying pain in PD is unclear and whilst studies have evaluated factors influencing PD pain, there is no consensus for clinical measures and biomarkers associated with pain in PD.

Methods: Using the Parkinson’s Progression Markers Initiative database, we assessed and compared semi-quantified [¹²³I]FP-CIT SPECT as a marker of dopamine transporter (DAT), cerebrospinal fluid (CSF) markers and motor and non-motor features from two groups of early de novo PD patients with pain (n=220) and without pain (n=200). We explored clinical and imaging correlates of pain and the predictive significance of these markers in the development of pain in Parkinson’s patients without pain.

Results: Parkinson’s patients with pain were more depressed (P=0.002), had reduced quality of life (P<0.001), and increased apathy (P=0.001), sleep disturbances (P<0.001) and fatigue (P<0.001) compared to patients without pain. The severity of pain was associated with depression (r=0.206; P<0.001), UPDRS-I Total (r=0.302; P<0.001), apathy (r=0.192; P<0.001), sleep disturbances (r=0.255; P<0.001), fatigue (r=0.299; P<0.001). Cox multivariate analysis, including all clinical and imaging data, revealed that sleep disturbances (P=0.011) and fatigue (P=0.011) are predictors of the future development of PD pain. In early stages, the presence of pain does not predict motor progression or cognitive decline.

Conclusions: Our findings indicate that pain in early de novo PD is associated with higher non-motor burden scores. Sleep disturbances and fatigue are predictors for pain development.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pain-and-parkinsons-disease/