Objective: To describe the new category of nociplastic pain (NP). We defined Parkinson’s disease (PD)-related pains and allocated them to a mechanistic category by using the PD Pain Classification System (PD-PCS) questionnaire [1].

Background: NP has been defined as pain with altered nociception following the exclusion of neuropathic and nociceptive pain [2]. NP pain in PD have been poorly described, which difficult their diagnosis and treatment.

Method: We evaluated 100 non-demented PD patients during the On phase in three centres by the PD-PCS questionnaire, which defines PD-related pain when 1 out of 4 criteria are met: pain is present at the beginning of the disease, or is aggravated at the Off-phase, or during dyskinesia, or responds to dopaminergic treatment. Then, the pain syndrome is allocated to a pain mechanism (neuropathic, nociceptive, and NP) in a hierarchical fashion. Finally, a severity score is obtained including intensity, frequency, and impact. In addition, demographic data, motor symptoms, pain (BPI), wearing-off (WOQ9), quality of life (PDQ8), mood (HADS), and cognition (MMSE, MoCA) were assessed.

Results: The mean disease duration was 7±5 yrs (mean age: 71±8 yrs). MDS-UPDRS III and IV scores were 30±13 and 4±4 points. 92% of the patients presented with at least one pain (1.9±1), with a duration of 7.5±10 yrs, and a rating of 3.7±2 on the numeric rating scale. 9% had neuropathic (2% central, 7% peripheral), 57% nociceptive (48% localized, 16% myofascial pain), 27% NP (21% leg motor restlessness pain, 5 % non-motor off, 2% others), and 54% exhibited non PD-related pain. NP patients presented with longer disease duration, higher motor scores, and more Off time. However, dopaminergic responsiveness of pain was similar in both groups (43 vs 44 %). Patients with NP pains had lower MMSE and MoCA scores. Finally, the severity score of NP was lower compared to other kind of pains.

Conclusion: Our results, obtained by the recently validated PD-PCS, suggest that NP is the second most common pain in PD including mostly motor restlessness and non-motor off pains with a relatively low severity score. However, pain assessment may be limited due to cognitive deterioration [3]. The findings of longer disease duration and increased off time in patients with NP pains, suggest that an optimized dopaminergic schedule may improve them [4].

References: 1. Mylius V, Perez Lloret S, Cury RG, Teixeira MJ, Barbosa VR, Barbosa ER, et al. The Parkinson disease pain classification system: results from an international mechanism-based
classification approach. Pain. 2021 Apr 1;162(4):1201-10.
2. Kosek E, Cohen M, Baron R, Gebhart GF, Mico JA, Rice AS, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016 Jul;157(7):1382-6.
3. Kunz M, Mylius V, Scharmann S, Schepelman K, Lautenbacher S. Influence of dementia on multiple components of pain. Eur J Pain. 2009 Mar;13(3):317-25.
4. Mylius V, Moller JC, Bohlhalter S, Ciampi de Andrade D, Perez Lloret S. Diagnosis and Management of Pain in Parkinson’s Disease: A New Approach. Drugs Aging. 2021
Jul;38(7):559-77.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characterization-of-nociplastic-pains-in-parkinsons-disease-pd-with-the-pd-pain-classification-system-pd-pcs/