Pain

Reviewed by: HU Medical Review Board | Last updated: January 2023

Pain is a common non-motor symptom of Parkinson’s disease (PD). About 9 out of 10 people with PD have some type of pain impacting their quality of life. Pain varies from person to person and is often hard to describe. This makes it hard for both those with pain and the doctors who treat them. In PD, there are several types of pain that can occur.1,2

Nerve pain

Nerve (neuropathic) pain is caused by damage to or dysfunction of the nervous system. This type of pain can occur in any area of the body. It is often described as a burning or shooting sensation.1

Parkinson's disease can cause this type of pain because the disease can damage the nerves.1

Nerve pain is diagnosed by ruling out other causes of pain. It can be treated with tricyclic antidepressants, anticonvulsants, and opioid painkillers. However, this type of pain is often hard to treat and can persist even after the underlying cause has been treated.3

Muscle, joint, and bone

Parkinson's disease can cause musculoskeletal pain because the disease can damage the muscles, bones, and joints. In addition, the muscles in people with Parkinson's disease can become weak and stiff.1,4

Musculoskeletal pain is diagnosed by ruling out other causes of pain. Drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen might help. Physical therapy and exercise may also be helpful.1,4

Dystonia is a type of muscle spasm that can cause pain. Dystonia is often described as a severe tightness or stiffness in the muscles. Dystonia can affect the limbs, neck, face, tongue, jaw, and trunk. It can even affect the muscles in the throat that control swallowing and the vocal cords.1,4

If you have PD with dystonia, you may experience your:1,4

  • Feet or toes curling painfully
  • Arm twisting behind your back
  • Head bending forward toward your chest

Dystonia can occur in people with Parkinson's disease when dopaminergic drugs used to treat PD wear off.4

Posture-related

Postural instability–related pain is caused by problems with posture and balance. This type of pain is often felt in the hips, back, and knees.1,4

People with PD often have issues with their balance, which makes them unsteady when standing. This is known as postural instability. People who have postural instability may easily fall if they are bumped or touched. Falls can be painful or disabling for some people with PD and may lead to a decreased quality of life. Signs of postural instability include:5

  • Stooped posture
  • Small, shuffling steps
  • A tendency to lean forward when walking

While some drugs that treat PD can help with postural instability, exercise and physical therapy often help more than drugs.5

Central pain

Central pain are painful sensations caused by damage to the areas of the brain or spinal cord where our senses are processed. Central pain is believed to be the only type of pain directly related to having Parkinson's disease. Thankfully, it is rare to have central pain. But this type of pain is known as the most severe form of pain in PD. People who have central pain describe it as feeling like:1,2,4

  • Bloating
  • Burning
  • Stabbing

Central pain is often constant, and can range from moderate to severe in how intense it feels. It is usually a constant pain, moderate to severe in intensity. If you have central pain, factors that can make it worse include:1,2,4

  • Changes in temperature
  • Your feelings and emotions
  • Movement
  • Touch

Central pain is hard to diagnose and treat. Sometimes, central pain can be managed by adjusting your PD drugs or taking a prescription painkiller. Talk to your doctor if you want to try these options.2

Impact on mental health

Living with chronic pain from PD can have a deep impact on your mental health. A study by the Parkinson’s Foundation found that mood, anxiety, and depression have greater influence on your overall health than the other symptoms of PD.6

Depression is a medical condition that deserves treatment. If you have depression, know that you are not alone in feeling this way. Your doctor can help you get the treatment you need.6

The different types of pain that can occur in PD can be challenging. Knowing the symptoms and treatments available can help guide your conversations with your doctor. Treatment can bring hope and reduce suffering for many. Ways to treat pain will vary from person to person, but include:1

  • Physical therapy
  • Exercise
  • Drugs that treat PD
  • Prescription painkillers
  • Other drugs, like antidepressants or muscle relaxers
  • Acupuncture or other complementary therapies

Managing your pain is a process that might take time. Partnering with your doctor will help you get the answers you need to live an active, fulfilling life with PD.

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