The Parkinson disease pain classification system: results from an international mechanism-based classification approach
The Parkinson disease pain classification system: results from an international mechanism-based classification approach
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
CH · Author affiliation · country only
Department of Neurology, Center for Neurorehabilitation, Valens, SwitzerlandLocation evidence
DE · Author affiliation · country only
Department of Neurology, Philipps University, Marburg, GermanyLocation evidence
Buenos Aires, AR · Author affiliation
Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), and Faculty of Medicine, Pontifical Catholic University of Argentina, Buenos Aires, ArgentinaLocation evidence
São Paulo, BR · Author affiliation
Pain Center, LIM-62, Departamento de Neurologia da Faculdade de Medicina da Universidade de Sao Paulo, Hospital das Clínicas, Sao Paulo, BrazilLocation evidence
London, GB · Author affiliation
King's College Hospital, Parkinson Foundation Centre of Excellence, London, United KingdomLocation evidence
Paris, FR · Author affiliation
INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Assistance Publique—Hôpitaux de Paris, Boulogne-Billancourt and Université Versailles-Saint-Quentin, FranceLocation evidence
Boulogne-Billancourt, FR · Author affiliation
INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Assistance Publique—Hôpitaux de Paris, Boulogne-Billancourt and Université Versailles-Saint-Quentin, FranceLocation evidence
Créteil, FR · Author affiliation
EA 4391, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine de Créteil, Université Paris-Est-Créteil, FranceLocation evidence
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Original abstract
Abstract Pain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 ± 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.