PAIN IN PARKINSON’S DISEASE: CHARACTERISTICS AND RESPONSES IN AMBULATORY CARE PATIENTS

Lisette Bunting-Perry, Univeristy of Pennsylvania

Abstract

Pain is often a disabling symptom in Parkinson’s disease (PD), and is currently underassessed, underdiagnosed, and undertreated in this population of primarily older adults. Guided by the Rugh Model of Psychological Components of Pain, an exploration of the characteristics of pain experienced by individuals with PD, and the relationships among the emotional, cognitive, perceptual, and behavioral aspects of pain was undertaken. A convenience sample of 125 patients with PD reporting average daily pain as 2 or greater on the Brief Pain Inventory-Short Form, were recruited for a cross-sectional descriptive survey from two large urban movement disorder centers. Multiple measures were used to assess PD symptoms, depression, attention, beliefs, pain severity, pain interference, quality of pain, and classification of pain symptoms. Multivariable data analyses included descriptive statistics, multiple regression analysis, and correlational techniques. Results demonstrated the strength of the Rugh Model for an examination of pain as a multidimensional experience in PD. Participants reported over two distinct pain symptoms each, with most symptoms classified as musculoskeletal pain. Additionally, most participants described pain as unrelated to idiopathic PD. Correlations with medium to large effect size supported the Rugh Model with significant relationships among pain severity, pain behavior, pain beliefs, depression, sensory quality of pain, and affective quality of pain. Multiple regression analysis demonstrated that 46% of the variance in Pain Interference was explained by pain severity, depression, and pain beliefs. A significant contribution of the study was the use of the International Association for the Study of Pain scheme for coding chronic pain diagnosis modified with M. A. Lee’s classification of pain in PD. Intervention trials should integrate assessment for depression in concert with effective strategies for pain management. Clinical research on pain in PD needs to move beyond pain as a sensory symptom and examine pain from a biopsychosocial perspective.