Table 1 Types of pain and specific features
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 |