To Everyone,

Received today from Ask the Doctor-Dr. Lieberman of the NPF.  I plan to
take a copy of this to my neuro.
E of the headdress

At 08:17 PM 2/25/2001 -0500, you wrote:
>***A message from Ask the Doctor***
>
>dear friend
> pain is part of parkinson disease
> please read the following
>9  Pain in Parkinson Disease
>          (1) Introduction
>       It’s said, “Pain and PD don’t go together.”  And when pain appears, its
said to be
>something else, “arthritis, bursitis, a “bad back”, a “frozen shoulder,”
fibromyalgia, a
>“pinched nerve,”a sprained muscle, or nerves.” But pain is part of PD, and
it has many
>forms.   In Chapter 1 you met Melvin, the state senator who’s PD started
with shoulder pain,
>pain his doctor’s attributed to an old football injury.  He was treated
with anti-inflammatory
>drugs, arthritis drugs, acupuncture, exercise,  massage, and pain killer
to no avail. It wasn’t
>until Melvin was diagnosed with PD, and his pain disappeared on Sinemet,
that it was
>attributed, correctly to PD.  In Chapter 5 you learned about discomfort of
Restless Legs, a
>condition associated with PD.  And you learned about the cramping pain of
dystonia: neck
>pain, leg pain, and arm pain.
>       How common is  pain is PD?  In my own experience 50% of people with PD at
one
>time complain of pain, and in perhaps 50% of them, 25% of all people with
PD, the pain is
>related to PD  and not something else.  The pain’s related to PD, if it
fits a  pattern, if it’s
>worse where PD’s worse, if it’s relieved by PD drugs such as Sinemet plus
Comtan, if
>there’s no other cause.
>          (2) The Pain of Rigidity
>       In the beginning,  before you’re diagnosed with PD, like Melvin you may
complain
>of a dull pain, like a sprain. The pain may be described as aching,
gnawing, or nagging.  The
>pain is usually confined to a shoulder, the neck, the back, or a hip.
These are either major
>weight bearing regions (the back, the hip). Or they’re pivots around which
multi- directional
>movements occur:  side-to-side, up-and-down, back-and-forth,
around-and-around. These
>pivots are the shoulder, the neck, and to a lesser degree the hip. The
elbows and knees are
>pivots, but uni-directional movements: back-and-forth (flexion and
extension).
>       This pain is probably related to the rigidity of PD which results in the
muscles
>becoming stiffer, “less elastic”, harder and more painful for them to
move. This type of pain
>“magically” disappears when Sinemet plus Comtan or a dopamine agonist is
started.
>       (3) The Pain of Dystonia
>       Before you’re diagnosed,  you may complain of a pain different from
Melvin. The
>pain may be described as cramping, sharp, stabbing, or throbbing.  It’s
more intense than
>Melvin’s pain. The pain is usually confined to one or both calves, or
forearms, or thighs, or
>upper arms. This pain is probably related to the dystonia of PD which
results in the muscles
>becoming hard. This  pain also magically disappears when Sinemet plus
Comtan or a
>dopamine agonist is started.  Dystonia is different from rigidity.
Although both make the
>muscles  hard, in rigidity the hardness results from the muscles becoming
“less elastic”,
>whereas in dystonia it results from the muscles contracting without
relaxing.   You may not
>be able to tell or describe the difference, but a neurologist with an  EMG
 (an
>electromyogram,  “a cardiogram of the muscle) can.
>       Dystonia of the calves, forearms, thigh, or upper arms,  may be an early
symptom of
>PD usually in people below age 40 years. It may appear in PD people who
are on  Sinemet.
>Usually it appears as Sinemet “wears off,” typically in the early morning
when Sinemet
>levels are low.  This is called an “off dystonia.”  It’s worse on the side
more affected by PD.
>It’s  is treated by adding Comtan or a dopamine agonist to prolong
Sinemet’s effect.  The
>pain of dystonia can appear as Sinemet peaks, called “on dystonia.”  It’s
harder to treat
>requiring re-arranging all your drugs to reduce the “highs” and “lows” of
Sinemet.
>       (4) Describe the Pain
>       Only you feel the pain, only you can describe it.  Be as specific as you
can.  The
>following is helpful.
>       Location: Where does it hurt most?  The shoulder?  The Hip?  The Back?
>       Does it stay in one place or does it radiate?  If so, where?  From the
shoulder down
>the arm?  From the back to the hip?  Knowing how a pain radiates, is like
knowing the road
>on which a car travels.
>       Intensity: How bad is it?  Describe it on a scale from “0" to “10", where
“0" is no
>pain, and “10" feels like your arm (or leg) was “yanked-off”, or your skin
was “ripped off.”
>The pain of PD is usually a 4, or 5, or 6, or 7.  It’s never a 10.
>       Duration: There are two parts.
>       1.  How long have you had the pain? Hours?  Days?  Weeks?  Years?
>       2.  During a typical day, how long does it last?  From the time you get
till breakfast?
>Till lunch?  Till dinner?  All day?
>       Associations: Is the pain associated with discoloration, inflammation,
redness,
>swelling, or warmth of the overlying skin?   The pain of PD shouldn’t  be
associated with
>any of the above.
>       Position: What, if any, positions make it better.  What, if any, make it
worse.
>       Quality: There are many ways to describe pain. Some have special meaning:
Words
>used include:  aching, biting, burning, cramping (like a Charlie-horse) ,
griping (like being
>caught in between a pair of pliers), hurting, nipping, pinching, ripping,
smarting, stabbing,
>and throbbing.
>       (5) Unusual Pain
>          Unusual pain may occur in PD and may be related to muscle spasm
(from dystonia)
> with pressure on an underlying nerve.  Although it’s the muscle that’s in
spasm, the pain is
>from the nerve.  The pain’s more intense than a muscle spasm, and radiates
along the nerve.
>The following may occur.
>       Spasm of the  piriformis  muscle (in the buttock) with pressure on the
sciatic nerve
>mimicking the pain from a herniated disc.
>       Spasm of the gastrocnemius muscle (in back of the calve) with pressure on
the
>peroneal nerve or spasm of the tibialis muscle (in front of the calve)
with pressure on the
>tibialis nerve causing calve or foot pain.   This may be responsible for
the intense leg or foot
>pain people experience when Sinemet “wears- off.”
>       Spasm of the pronator muscle in the forearm with pressure on the median
nerve, or
>spasm of the extensor muscles of the wrist with pressure on the radial
nerve with pain down
>the forearm.
>       If spasm of a muscle is the cause of the underlying nerve pain, the
treatment is
>injecting botulinum toxin into the muscle, reducing the spasm and
freeing-up the nerve.
>       A diffuse, not well localized, burning or throbbing pain may sometimes occur
>in an arm or a leg, or across the chest. Whether this is related to PD, or
anxiety, or
>depression is difficult to pin down. It probably results from a disordered
Autonomic Nervous
>System.
>       (6) Treatment
>          Pain resulting from PD usually respond to PD medication: Sinemet
plus Comtan or
>a dopamine agonist.  Pain that responds in part, or pain that’s not PD,
may be treated as such
>pain is usually treated. Because many PD people have “sensitive stomachs”
(see The
>Stomach in Parkinson), I prefer drugs such as Celebrex or Vioxx, drugs
that decrease pain
>but rarely  upset the stomach or cause bleeding.
>          Anxiety and depression make pain worse, the pain from rigidity,
or dystonia, or a
>          disordered Autonomic Nervous System.  Master your anxiety, or
your depression
>          and your pain may disappear.
>
>
>
>I also have experienced a lot of muscle cramping in the last year. One
>episode even landed me in intensive care on the theory it was heart
>problems. They started soon after Sinemet was added to the Mirapex I was
>already on. Last week the doctor cut the Mirapex in half to .5 mg. 3 times a
>day and kept the Sinemet at 25/100 3 times a day. I have had the first 5
>painfree days in over a year. I wonder if it was a case of over-medication
>or a fluke!
>
>
>---
>You are currently subscribed to askthedoctor as: [log in to unmask]
>To unsubscribe send a blank email to
[log in to unmask]
>
>