Objective: To assess the factors defining the association of chronic pain (>3 months) with PD.

Background: Non-motor symptoms can be often associated with Parkinson disease (PD) to set the treatment approach. The PD Pain Classification System (PD-PCS) proposed four factors defining the association of chronic pain with PD [1].

Method: We evaluated 120 non-demented PD patients with the PD-PCD during the On-phase in four centres in Switzerland. According to the PD-PCS, PD-associated pain was considered when 1 out of 4 criteria were met: criteria 1: Pain starting with motor symptoms or aggravated by the disease; criteria 2: pain at the OFF-phase; criteria 3: pain during choreatic dyskinesia (ON-phase); and criteria 4: pain responding to dopaminergic treatment. The scale then allows to hierarchically allocate the PD-related pain syndrome to a pain category (i.e., neuropathic, nociceptive, and nociplastic). Finally, a severity score is obtained including intensity, frequency, and impact.

Results: Mean (±SD) age was 69.9±8.64, 74 patients were males (61.7%). Mean UPDRS III score in the ON-state was 30.1±13.7, 32 patients had dyskinesias (27.2%), and 43 had motor fluctuations (35.7%). 105 patients (88.3%) reported a total of 188 pains. Among these patients, 71 (67.6%) reported more than one pain. Non-PD related pain was reported by 64 (53.3%). Among the PD related pain, nociceptive pain was reported by 71 (59.2%) patients, neuropathic pain (NP) by 10 (8.3%), and nociplastic pain by 30 (25.0%). Considering all pain categories together, “pain at motor symptom onset or aggravated by the disease” was reported by 39 / 105 patients (37.1%), “pain at the OFF-phase” by 78/105 (74.3%), “pain during choreatic dyskinesia (ON-phase)” by 11/105 (10.5%), and “pain responding to dopaminergic treatment” by 83 (79.0%). Table 1 shows the number of patients fulfilling each PD-PCS criteria for PD-related pain, segregating by pain category.

Conclusion: Among the PD-PCS criteria for PD-related pain, “improvement with dopaminergic treatment” and “pain at the OFF-phase” were the most frequently reported ones, followed by “pain at motor symptom onset or aggravated” and “pain during dyskinesia (ON-phase)”. All four criteria reflect different aspects, and their use should facilitate further diagnostics, classification, and treatment of pain in PD [2].

Table 1

References: 1. V. Mylius, S. Perez Lloret, R.G. Cury, M.J. Teixeira, V.R. Barbosa, E.R. Barbosa, L.I. Moreira, C. Listik, A.M. Fernandes, D. de Lacerda Veiga, J. Barbour, N. Hollenstein, M. Oechsner, J. Walch, F. Brugger, S. Hagele-Link, S. Beer, A. Rizos, K.R. Chaudhuri, D. Bouhassira, J.P. Lefaucheur, L. Timmermann, R. Gonzenbach, G. Kagi, J.C. Moller, and D. Ciampi de Andrade, The Parkinson disease pain classification system: results from an international mechanism-based classification approach. Pain 162 (2021) 1201-1210.
2. V. Mylius, J.C. Moller, S. Bohlhalter, D. Ciampi de Andrade, and S. Perez Lloret, Diagnosis and Management of Pain in Parkinson’s Disease: A New Approach. Drugs Aging 38 (2021) 559-577.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/criteria-defining-chronic-pain-associated-with-parkinson-disease/