Leg Pain in Parkinson's Disease: 4 Common Types

One of the biggest complaints I hear from people with Parkinson's disease (PD) is severe leg pain. As a fellow, if I had heard someone complain of pain in their leg, I would not have thought it was due to Parkinson’s.

My grandmother often complained of deep pain in her calves and in her legs, which started before her tremors and shuffling were noticeable. Never did I imagine that leg pain would be a pre-clinical or early symptom of PD. I assumed her pain was neuropathic in nature due to her diabetes.

An early symptom

Interestingly enough, 1 of my early symptoms of the disease was deep searing pain in my left leg, the type of pain my grandma had complained about many times. Initially, this type of pain was worst in the morning as well as at night, making me think it was some sort of fasciitis.

However, not only did typical anti-inflammatories and muscle relaxants not alleviate my pain, but the pain worsened over time to a constant burning pain that felt as if someone was tearing the muscle and pouring hot oil on it.

The pain was so excruciating it was permeating into all aspects of my life. I was constantly in need of deep tissue massage, asking my husband to massage my legs just as my grandmother had asked of us time and time again. This helped only temporarily.

Which brings me to the 4 types of leg pain in PD.

Central pain

This pain is described as a constant burning sensation with occasional bursts of sharp pain. In my case, this pain was commonly exacerbated by cold and light touch.

I could not stand the sheets touching my skin, and being in a cold room sent my pain through the roof. This type is usually bilateral, but it may start on the side where other Parkinson’s symptoms begin. For me, it was the leg where my rest tremor began.

Dystonia

When related to levodopa, it usually occurs as a wearing off but can also occur at peak dose. In most cases, this leg pain is unilateral and directly correlates with medication intake.

When pain is due to dystonia, it is more common in the early morning. This type of leg pain is usually accompanied by toes curling and abnormal foot posturing.

Musculoskeletal

Musculoskeletal pain occurs due to rigidity, abnormal posturing, and lack of mobility, leading to pain in the legs.

It may also affect joints like the hip or knee. This pain is usually more pronounced on the more affected side. It can be localized or widespread and may start suddenly.

Radicular pain

In this case, the pain is caused by compression of nerves in the lumbar area, which results in weakness, numbness, tingling, and loss of reflexes from the buttocks to the foot in the distribution of a nerve. It can be acute or chronic, and can be worse with standing and sitting, or better with lying down.

Of note: in my experience, many patients, including myself, have these symptoms not because of a physically herniated disc but rather because of the stretching of a nerve in the canal as it exists due to severe musculoskeletal rigidity and abnormal posturing.

Treatment options

Treatment depends on properly identifying the type. If pain is bilateral, always assume it is central pain (pain due to PD). In my experience, Azilect works great for this type of pain. Other medications can also be used for this pain.

Massage therapy works for all types of leg pain - my favorite therapy but can be costly. Water therapy may also work for all types except central pain. Physical therapy (PT) can alleviate dystonia pain, as well as musculoskeletal and radicular pain.

If pain is due to dystonia related to levodopa intake, find out when it occurs- at the end of the dose or at peak dose. Typically, adjusting medication doses will resolve the problem. However, if dystonia is an initial symptom of PD, initiating treatment with levodopa will resolve.

If medication adjustment does not work well for levodopa-induced dystonia, another treatment option is deep brain stimulation. Pain due to dystonia independent of cause can also respond well to Botox injections, as well as centrally acting muscle relaxants.

To avoid and alleviate pain caused by stiff muscles, a great treatment option is activity in the form of stretching exercises - any number of activities will do, such as tai chi or yoga. For me, when I start having radicular pain shooting down my leg, it is time to up my levodopa dosage.

If you have leg pain, be sure to discuss it with your physician.