[Parkinson's Disease with Intolerable Painful Dystonia: Classification and Therapeutic Choices of Pain in Parkinson' Disease].
[Parkinson's Disease with Intolerable Painful Dystonia: Classification and Therapeutic Choices of Pain in Parkinson' Disease].
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Original abstract
Disabling painful dystonia is one of the most burdensome symptoms that a patient with Parkinson's disease (PD) experiences. How do we treat disabling painful dystonia in PD? In this review, classification and mechanisms of pain and their management in PD especially for dystonia-related pain are described. Moreover, painful bilateral dystonic foot spasm is also an important development to be considered in the early stage of the disease. Recent classification of pain in PD does not involve this symptom, partly because this symptom is relatively unobserved due to early initiation of treatment in PD patients. Treatment options for dystonia-related pain are diverse and are necessarily contingent on the cause of dystonia in PD. Reducing L-dopa and other drugs is useful for patients with on-dystonia and dyskinesia-related pain in PD. Increasing L-dopa and other drugs are better for early morning dystonia and off-period dystonia-related pain in PD. Finally, as severe and troublesome painful dystonia is often challenging to treat, continuous dopaminergic stimulation such as treatment with levodopa-carbidopa intestinal gel is considered effective for these symptoms.