Pain

Pain can occur in people with Parkinson's disease (PD). As Parkinson’s progresses, it is common to experience changes in the spine, hands and feet that can be uncomfortable.  

Understanding Pain

Parkinson’s disease pain is divided into five categories:

1. Musculoskeletal: Musculoskeletal pain is due to the disease affecting the bones, muscles, ligaments, tendons and nerves. It can occur suddenly or be long-lasting and can occur in one area or several.
2. Neuropathic/radicular: Neuropathic/radicular pain is due to damage to nerves occurring anywhere from where the fibers leave the spinal cord to where they end in the skin.
3. Dystonic: Dystonic pain is from sustained or repetitive muscle twisting, spasm or cramp that can occur at different times of day and in different stages of Parkinson’s.
4. Akathisia: Akathisia is the feeling of restlessness or inability to be still.
5. Central Pain: Central pain is pain due to the pathways which control sensation and pain in the brain, brainstem, and spinal cord not working properly.

Nearly every person who lives with PD will experience some degree of muscle rigidity. Common experiences include bending of the neck, curling of the trunk with slumping of the shoulders and bending at the wrists, fingers, elbows, hips and knees. These changes may progress over time.

A third or more people with Parkinson’s eventually experience changes in posture, although this occurs most often in those with advanced PD. Some people experience severe postural changes with extreme leaning forward or to one side.

Other common changes include dystonia, muscle spasms, and cramps that are particularly common in the feet. Osteoporosis can also occur and lead to weakened bones which can increase risk of falls and fractures. It is important to look at the impact of orthopedic surgeries for non-PD related spine deformities, hip and knee replacement, and other bone problems. Although people with Parkinson's can benefit from such surgeries, they may have a longer and more complicated recovery than people without PD.

Rigidity, weakened muscles, and involuntary muscle contractions (dystonia) can cause painful deformities for people with PD. A tilted or twisted spine can also throw a person off balance and increase the risk of falling.

Common Skeletal & Bone Changes with PD 

• Frozen shoulder: stiffness, pain and loss of range of movement in the shoulder, many people experience this symptom before a PD diagnosis.
• Flexed fingers, toes or feet (striatal hand and foot): one finger may extend, the thumb may fold inwards, fingers may clamp down onto the palm. In the leg, the foot may flex down or turn in, the big toe may flex upward while the other toes curl under.
• Stooped posture (camptocormia): the spine bends forward when walking, in the most severe cases by as much as 90 degrees. This posture arises because the hips and knees are flexed and will go away when lying down.
• Leaning sideways (Pisa syndrome): involuntarily tilting of the trunk to one side when sitting, standing or walking; always to the same side.
• Scoliosis: sideways twisting, or curvature, of the spine.
• Dropped head (anterocollis): the head and neck flex forward; the chin may drop all the way down to the sternum or breastbone (more common in multiple system atrophy than PD).
• Bone fractures: people with PD are at risk of broken bones from falling, especially from landing on the hip. Kneecap fractures also are common, painful and sometimes overlooked.
• Low bone density/osteoporosis: bones may become weak and at risk for osteoporosis from lack of weight-bearing exercise, like walking, and from too little calcium and vitamin D. Other risk factors for osteoporosis include older age, female sex, low body weight, and smoking. A person with PD who has osteoporosis is more likely to break a bone if they fall.

Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor and Dr. Amelia Heston, Movement Disorders Fellow at the University of Michigan.