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Persistent Pain and Parkinson's

Persistent pain can be commonly found in those with Parkinson’s. Some studies show that pain can be seen in 50% of people living with advanced Parkinson’s. However, not all pain is created equal. Let’s talk about it. 




Did you ever have a paper-cut and it hurt so bad even though it didn’t bleed or just barely bled? Did you ever wake up with bruises on your legs or arms and not remember how you got them? These are just some examples on how pain is not necessarily correlated to tissue damage. How could one small tiny little cut lead to so much pain? How can a big nasty bruise not produce any pain at all? The answers all lie in our brains. Let’s say you touch a hot stove and bam your fingers hurt. There are no special pain sensors in our fingers that tell us we are in pain from the hot stove. Information gets collected from nerves along your fingers and gets sent up to the spinal cord and then the brain. Our brain then processes that information and decides if it is threatening or nonthreatening. If our brain perceives it as threatening, it then sends a pain signal and tells you to move your hand ASAP. Within fractions of a second, our brain scans the environment, looks back on past experiences, takes into account cultural norms, and so much more. There is so much that goes into our brain’s decision to send a pain signal, more than we know. This stuff can get pretty complicated so let’s boil down pain to 3 different mechanisms. 



Pain mechanisms


1. Nociceptive pain 

This is your acute pain that has very clear movements or positions that worsen your pain, and very clear movements or positions that relieve your pain. The pain is also very localized to the injury site. Think about spraining your ankle. For a few days walking on it hurts but over time it gets better and eventually the pain goes away.


2. Neuropathic pain 

This type of mechanism can include numbness, tingling, and pins and needles. Often, these sensations might travel down a leg or arm. Sciatica is a common example. 


3. Nociplastic pain (persistent pain)

This type of pain is much more complex (but my personal favorite). Type pain mechanism involves more persistent pain that is widespread and pain that lasts for longer than normal tissue healing. You may have more constant pain, it may impact your sleeping, and it is not easily relieved or it takes a lot more to relieve the pain compared to creating the pain. This is where I believe most people with PD fit into. 


It is very important to note that it is more common to have a mixture of different types of pain mechanisms. For example: someone who recently sprained their ankle but has more widespread symptoms throughout their entire lower leg and foot (not just their ankle). They would fit into both nociceptive and nociplastic.




Factors that contribute to nociplastic pain 


Let me be clear, we, as a science community, do not have all the answers on this topic. To date, there is no one specific answer as to why people develop persistent pain. However, there are lots of different factors that make people more at risk. These can be high stress, depression, anxiety, poor social support, lack of physical activity and exercise, fear avoidance behaviors, chronic inflammatory conditions (like IBS or chrons), poor diet, and poor sleep. In those with PD, the lack of dopamine production can be a big factor as well as several non-motor and motor symptoms. Non-motor symptoms may include fatigue, poor sleep, anxiety, depression, and apathy. Motor symptoms may include weakness, stiffness, slowness, dyskinesias and tremors. Other factors may include altered inflammatory signals that occur with PD that promote a pro-inflammatory environment.



How to get relief 

Find a physical therapist that specializes or is educated in persistent pain. There has been a big shift in how to treat people with persistent pain over the last 10-15 years, but many PT schools and continuing education companies are still not teaching it. Find a provider that emphasizes a biopsychosocial approach to their care and is well versed in nociplastic pain. 


Breath-work can be very helpful for people to get their nervous system and brain to be less on guard. Try deep breathing exercises like diaphragmatic breathing including boxed breathing and paced breathing.


Work on other lifestyle behaviors like stress, sleep, and diet. These things play a big role in making one’s ecosystem more susceptible to persistent pain. 


Exercise and stay active. A body in motion stays in motion. Nothing is worse than to stop moving or to avoid an activity. If you continue to avoid activities, your brain and nervous system will be more on guard when you end up doing the activity and more likely to perceive it as threatening.



If you have trouble with persistent pain, talk with your physical therapist to see what factors may be driving your symptoms. 




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