Objective: We investigated associations between clinical features, neuroanatomical changes and pain in early de novo Parkinson’s disease (PD) patients.

Background: Pain is a common and troublesome symptom encountered by PD patients. Being able to identify patients at risk of developing chronic pain could lead to improvements in management.

Method: The Parkinson’s Progression Markers Initiative database was utilised to identify 421 patients. They were grouped based on the presence of persistent pain – defined as pain at all assessments (follow up range 3-60 months). We explored neuroanatomical differences between those with (n=53) and without (n=368) persistent pain using voxel-based morphometry (VBM) performed on their baseline MRI brain scan. Furthermore, associations between baseline clinical features and persistent pain were evaluated.

Results: The presence of persistent pain was associated with areas of volumetric loss. The regions of strongest correlation were the raphe nuclei (r=-0.164; P=0.001), pontis oralis (r=-0.158; P=0.002), and locus coeruleus (r=-0.131; P=0.01). These results remained significant with age as a covariate. Persistent pain was associated with increased severity of fatigue (r=0.240; P<0.001), light headedness (r=0.147; P=0.003), sleep disturbance (r=0.133; P=0.006) and apathy (r=0.127; P=0.009) at baseline assessment. There was no correlation with baseline motor assessment.

Conclusion: This study demonstrates that PD patients with persistent pain have atrophy in the raphe nuclei, pontis oralis and locus coeruleus. These brain regions have known importance for the descending control of pain. They are also important for sleep regulation, which is of particular interest given the association between early sleep disturbance and persistent pain identified in this study. Identifying predictive factors for the development of chronic pain in PD could enable targeted management for at risk patients. This abstract has also been submitted for presentation at the European Academy of Neurology Congress June 2019.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuroanatomical-and-clinical-predictors-of-pain-in-patients-with-early-de-novo-parkinsons-disease/