Objective: To evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the different characteristics of pain in patients with Parkinson disease (PD).

Background: Pain is a common and disabling non-motor symptom of PD. [1] Pathophysiological basis of sensory disturbances and pain in PD are not completely understood and its management remains a challenge. [2] Motor complications are the major indication of subthalamic nucleus deep brain stimulation (STN-DBS); however, pain reduction after STN-DBS has been noted. [3]

Method: We performed an observational prospective study. Fifteen patients with PD and refractory motor symptoms submitted to STN-DBS were evaluated preoperative and 12 months after surgery. Demographic data and motor examination (UPDRS part III; Hoehn and Yahr staging) were obtained. Pain was evaluated using King’s PD Pain Scale (KPPS) total score and 7 domains. This cohort was also compared to a similar group of patients on continuous subcutaneous apomorphine infusion (APO).

Results: Preliminary analysis included 8 patients submitted to STN-DBS (median age: 65.75±3.58 [59-71] years, 37.5% females) and 5 patients on APO (median age: 60.60±8.65 [47-69] years, 40% females). Mean DP duration was 14.50±3.59 [12-20] years on DBS group and 14.80±5.07 [6-19] years on APO group.
There was a significant reduction on total KPPS score from 24.75±15.48 [7-56] on baseline to 4.75±4.23 [0-13] on follow up (p=0.012) in patients submitted to STN-DBS; the analysis of KPPS domains revealed a significant reduction in musculoskeletal pain (p=0.024) and fluctuation-related pain (p=0.011). The differences in the KPPS item fluctuation-related pain between baseline and follow-up did not correlate with the difference in UPDRS item 4.3 (percentage time in off) with a Spearman’s correlation coefficient of 0.065.
Comparing the 2 groups, there was a statistically significant difference on total KPPS score (p=0.019) between patients submitted to DBS and patients prescribed with APO after a 12 months follow-up with lower values in DBS patients; the analysis of KPPS domains revealed a statistical significative difference on fluctuation-related pain (p=0.011).

Conclusion: STN-DBS improved pain after surgery but had different effects in different types of PD-related pain. The mechanisms by which STN-DBS improves pain in PD may extend beyond reduction of motor fluctuations.

References: [1] Rukavina K, Leta V, Sportelli C, Buhidma Y, Duty S, Malcangio M, et al. Pain in Parkinson’s disease: New concepts in pathogenesis and treatment. Curr Opin Neurol. 2019;32(4):579–88.
[2] Kim HJ, Jeon BS, Paek SH. Effect of deep brain stimulation on pain in Parkinson disease. J Neurol Sci. 2011;310(1–2):251–5.
[3] Jung YJ, Kim HJ, Jeon BS, Park H, Lee WW, Paek SH. An 8-year follow-up on the effect of subthalamic nucleus deep brain stimulation on pain in Parkinson disease. JAMA Neurol. 2015;72(5):504–10.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-subthalamic-nucleus-deep-brain-stimulation-on-pain-in-parkinson-disease-real-life-observational-prospective-study/