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Table 1 Types of pain and specific features

From: Opicapone versus placebo in the treatment of Parkinson’s disease patients with end-of-dose motor fluctuation-associated pain: rationale and design of the randomised, double-blind OCEAN (OpiCapone Effect on motor fluctuations and pAiN) trial

Type of pain Features (Ford 2010, Valkovic 2015, Edinoff 2020)
Musculoskeletal pain • Aching, cramping, arthralgic, myalgic sensations in joints and muscles
• May include muscle tenderness, arthritic changes, skeletal deformity, limited joint mobility, postural abnormalities, and antalgic gait
• May be exacerbated by parkinsonian rigidity, stiffness and immobility, and alleviated by mobility
• May fluctuate with medication dose and improves with levodopa
Radicular or peripheral neuropathic pain • Pain in root or nerve territory, associated with motor or sensory signs of nerve or root entrapment
Dystonia-related pain • Associated with sustained twisting movements and postures; muscular contractions often very forceful and painful
• May fluctuate closely with medication dosing: early morning dystonia, OFF dystonia, beginning-of-dose and end-of-dose dystonia, peak dose dystonia
Primary/central pain • Burning, tingling, formication, ‘neuropathic’ sensations; often relentless and bizarre in quality, not confined to root or nerve territory
• Pain may have an autonomic character, with visceral sensations or dyspnoea, and vary in parallel with the medication cycle as NMF
• Not explained by rigidity, dystonia, musculoskeletal or internal lesion
Akathitic discomfort/other pain • Primary headache, visceral, arthritic, non-radicular low back pain, oral and genital pain
• Unpleasant agitating sensation associated with restless legs syndrome
  1. NMF non-motor fluctuations, PD Parkinson’s disease