Objective: To investigate whether regional pain syndromes can be an early clinical biomarker for prodromal PD without motor signs

Background: The disease-related changes in Parkinson’s disease (PD) can commence decades before the typical motor symptoms appear. While motor symptoms are the hallmark of PD, non-motor symptoms, such as pain, can also be present.

Method: Using a case-control design, we conducted a pilot survey in a combined hospital and community-based observational study. We assessed regional pain syndromes in 1000 individuals (>50 years) residing in an urban community by conducting verbal questionnaires and reviewing their medical records. Using MDS research criteria, we calculated the likelihood ratio (LR) for prodromal PD and categorized the participants into two groups: the prodromal PD group (LR > 80%) and the control group (LR < 80%). We examined the occurrence of various regional pain syndromes in 190 PD patients (disease duration < 2yrs) who visited our neurology OPD, which constitutes our clinical PD group.

Results: The results showed that 64 subjects (6.4%) had more than 80% LR for developing PD. The prevalence of pain was significantly higher in the prodromal PD group (71.8%) and clinical PD group (63.15%) than in the control group (30.76%). Regional pain syndromes like cervicalgia and pain in the shoulder, pelvic, thigh, and lower back regions are significantly more prevalent in the clinical and prodromal PD groups than in the control group. Frozen shoulder, RLS, and nocturnal leg cramps were significantly more prevalent in the clinical and prodromal PD group compared to the control.

Conclusion: The prevalence of different pain syndromes was notably higher in the prodromal group compared to the control group. Conversely, the presence and distribution of pain were similar in the prodromal PD and clinical PD groups. These results indicate that pain could be a crucial early clinical indicator of prodromal PD. Nevertheless, further longitudinal studies are required to validate the predictability of pain for future PD evolution.

References: Beiske AG, Loge JH, Ronningen A, Svensson E. Pain in Parkinson’s disease: prevalence and characteristics. PAIN 2009;141:173–7

Defazio G, Berardelli A, Fabbrini G, Martino D, Fincati E, Fiaschi A, Moretto G, Abbruzzese G, Marchese R, Bonuccelli U, Del Dotto P, Barone P, De Vivo E, Albanese A, Antonini A, Canesi M, Lopiano L, Zibetti M, Nappi G, Martignoni E, Lamberti P, Tinazzi M. Pain as a nonmotor symptom of Parkinson disease: evidence from a case-control study. Arch Neurol 2008;65:1191–4

E. Tolosa, Y. Compta, C. Gaig The premotor phase of Parkinson’s disease

Lee MA, Walker RW, Hildreth TJ, Prentice WM. A survey of pain in idiopathic Parkinson’s disease. J Pain Symptom Manage 2006;32:462–469

Negre‐Pages L, Regragui W, Bouhassira D, Grandjean H, Rascol O. Chronic pain in Parkinson’s disease: the cross‐sectional French DoPaMiP survey. Mov Disord 2008;23:1361–1369

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MDS Abstracts - https://www.mdsabstracts.org/abstract/regional-pain-syndromes-a-potential-clinical-biomarker-of-prodromal-parkinsons-disease/