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Eur J Pain. 2019 May 9. doi: 10.1002/ejp.1413. [Epub ahead of print]

Unveiling the Relationship Between Central Parkinsonian Pain and Motor Symptoms in Parkinson's Disease.

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Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.
Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.
Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.
Centre for Health Technology and Services Research (CINTESIS), University of Porto, Portugal.
Institute for Molecular and Cell Biology (IBMC), University of Porto, Portugal.
National Observatory for Pain - NOPain, Faculty of Medicine, University of Porto, Portugal.
Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal.
Department of Experimental Biology, Faculty of Medicine, University of Porto, Portugal.



Pain in Parkinson's disease (PD) is a common and heterogeneous non-motor symptom. Though the characteristics and predictors of pain in general and of central pain in particular are still largely unknown.


A semi-structured interview, the Brief Pain Inventory, and the Pain Disability Index were used to identify and characterize pain in a consecutive series of 292 PD patients. Unified Parkinson's Disease Rating Scale-III, Hoehn & Yahr, Schwab and England Independence Scale, and Freezing of Gait Questionnaire were applied to assess motor symptoms and functional independence in off and on conditions. Hospital Anxiety and Depression Scale and Questionnaire of Impulsive-Compulsive Control Disorders were used to screen for anxiety, depression and impulse control disorders.


Two hundred and twelve patients (73%) reported pain, which was classified as: musculoskeletal (63%), dystonia-related (27%), central parkinsonian (22%), and/or radicular or neuropathic (9%). Patients with pain had more comorbidities and more severe motor symptoms. Patients with central parkinsonian pain were significantly younger, had earlier disease onset, fewer comorbidities, greater non-axial motor symptom severity in on, more pain-related disability, and more relief of pain with antiparkinsonian medication than patients with non-central parkinsonian pain.


PD patients with central parkinsonian pain have some distinctive demographic and clinical features, including lower levodopa responsiveness of motor appendicular/limb symptoms to levodopa, associated with greater responsiveness of pain symptoms to these same medications. These findings suggest the need for a more integrated approach to motor and non-motor symptoms in these patients' clinical care. This article is protected by copyright. All rights reserved.


Parkinson's disease; central parkinsonian pain; motor symptoms; pain


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