Objective: To explore whether there is a link between chronic visceral pain and white matter hyperintensities (WMH) on brain magnetic resonance imaging (MRI) in People with Parkinson’s disease (PD, PwP).

Background: Pain is a challenging non-motor symptom (NMS) of PD; its pathophysiology is elusive and treatment options suboptimal. [1] In PD, WMH have been associated with motor (bradykinesia, tremor, freezing of gait) and NMS (cognitive impairment, apathy, fatigue, depression, anxiety); while in PD-free individuals, an association between several chronic painful conditions (migraine, tension-type headache, chronic low back pain) and WMH has been suggested. [2] [3] [4] [5] [6] [7] [8]

Method: An exploratory, cross-sectional analysis of the ongoing prospective, observational study “Non-motor International Longitudinal Study” (UK National Institute for Health Research Clinical Research Network (UKCRN)No.10084). Socio-demographic characteristics and PD-history were noted from this database. Presence of cardio-vascular risk factors was obtained from the medical records. King’s Parkinson’s Disease Pain Scale (KPPS) was used to identify and classify PD-related pain. [9] WMH were rated on the MRI images (1.5 Tesla General Electric (GE) Signa HDx or a 1.5 Tesla Siemens Avanto MRI system) using a semiquantitative Age Related White Matter Changes (ARWMC) scale. [10] Using Spearman’s correlation, associations between subtypes of PD-related pain and ARWMC scores were examined (SPSS, Version 26).

Results: 36 PwP (36.1% female, mean age: 61.11±10.48yrs, median disease duration 2yrs (0 – 14), median HY II (I – IV), mean LEDD 530.87±484.31mg) were included in our analysis. Mean KPPS total score was 18±13.16; median ARWMC score 1 (0 – 3). 30.56% participants had hypertension, 2.78% diabetes, 8.3% were obese and none had dyslipidemia. ARWMC scores and subjective ratings of chronic visceral pain (KPPS, Item 3) showed statistically significant positive correlation (r_s=0.427, p=0.009). Figure 1. No such correlation was found for any other pain sub-type.

Conclusion: Chronic visceral PD-related pain may be linked with brain MRI WMH; whether early interventions targeting underlaying mechanisms might offer potential opportunities for pain relief in a subset of PwP is unclear.

References: 1. Rukavina, K., et al., Pain in Parkinson’s disease: Mechanism-based treatment strategies. Curr Opin Support Palliat Care, 2021. 15(2): p. 108-115.
2. Lee, J.Y., et al., Association between White Matter Lesions and Non-Motor Symptoms in Parkinson Disease. Neurodegener Dis, 2018. 18(2-3): p. 127-132.
3. Buckalew, N., et al., White matter hyperintensity burden and disability in older adults: is chronic pain a contributor? PM R, 2013. 5(6): p. 471-80; quiz 480.
4. Dadar, M., et al., White matter hyperintensities mediate the impact of amyloid ss on future freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord, 2021. 85: p. 95-101.
5. Scamarcia, P.G., et al., Longitudinal White Matter Damage Evolution in Parkinson’s Disease. Mov Disord, 2022. 37(2): p. 315-324.
6. Linortner, P., et al., White Matter Hyperintensities Related to Parkinson’s Disease Executive Function. Mov Disord Clin Pract, 2020. 7(6): p. 629-638.
7. Zhang, Y., et al., White matter hyperintensities: a marker for apathy in Parkinson’s disease without dementia? Ann Clin Transl Neurol, 2020. 7(9): p. 1692-1701.
8. Yalcin, A., et al., Episodic Migraine and White Matter Hyperintensities: Association of Pain Lateralization. Pain Med, 2018. 19(10): p. 2051-2057.
9. Chaudhuri, K.R., et al., King’s Parkinson’s disease pain scale, the first scale for pain in PD: An international validation. Mov Disord, 2015. 30(12): p. 1623-31.
10. Wahlund, L.O., et al., A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke, 2001. 32(6): p. 1318-22.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/chronic-visceral-pain-in-parkinsons-disease-and-link-with-white-matter-hyperintensities/