Abstract
The prevalence of musculoskeletal (MSK) pain in people with Parkinson's disease (PD) is higher than that of age-matched controls. In this review, we outline what is known about MSK pain in PD, focusing on the neck, shoulder, knee, hip and low back. We also compare what is known about MSK pain in PD to what is known in older adults without PD. Finally, we outline areas of for future research related to MSK pain in people with PD.
Lay abstract
Joint pain in people with Parkinson's disease (PD) is more common than other healthy older adults. In this paper, we describe what is known about joint pain in PD, focusing on the neck, shoulder, knee, hip and low back. We also compare how much is known about pain in PD versus how much is known about pain in older adults without PD. Finally, we suggest ways future researchers can help the world better understand pain in PD.
Tweetable abstract
Musculoskeletal pain in Parkinson's disease: a narrative review. Musculoskeletal pain is prevalent in individuals with Parkinson's disease. What do we know about it and how might we study it going forward?
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1. . DoPaMiP Study Group. Chronic pain in Parkinson's disease: the cross-sectional French DoPaMiP survey. Mov. Disord. Off. J. Mov. Disord. Soc. 23(10), 1361–1369 (2008).
- 2. . Prevalence of pain in Parkinson's disease: a systematic review using the modified QUADAS tool. Mov. Disord. Off. J. Mov. Disord. Soc. 27(4), 480–484 (2012).
- 3. . Non-motor complications in late stage Parkinson's disease: recognition, management and unmet needs. Expert Rev. Neurother. 3, 1–18 (2021).
- 4. Pain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy. J. Neurol. 264(4), 758–769 (2017).
- 5. . The premotor phase of Parkinson's disease. Parkinsonism Relat. Disord. (Suppl. 13), S2–7 (2007).
- 6. . Parkinson's disease symptoms: the patient's perspective. Mov. Disord. Off. J. Mov. Disord. Soc. 25(11), 1646–1651 (2010).
- 7. . Quality of life and pain in Parkinson's disease: a controlled cross-sectional study. Parkinsonism Relat. Disord. 10(3), 129–136 (2004).
- 8. . Pain in Parkinson's disease. Mov. Disord. Off. J. Mov. Disord. Soc. 25(Suppl. 1), S98–S103 (2010). •• Describes different categories of pain seen in Parkinson's disease (PD) and describes a framework for diagnosing and treating pain within the PD population.
- 9. King's Parkinson's disease pain scale, the first scale for pain in PD: an international validation. Mov. Disord. Off. J. Mov. Disord. Soc. 30(12), 1623–1631 (2015).
- 10. The Parkinson's disease pain classification system (PDPCS): results from an international mechanism-based classification approach. Pain. 162(4), 1201–1210 (2020). • Presents the findings of an investigation of a new classification system for pain in PD.
- 11. . Pain in Parkinson's disease: prevalence and characteristics. Pain 141(1–2), 173–177 (2009).
- 12. A detailed clinical study of pain in 1957 participants with early/moderate Parkinson's disease. Parkinsonism Relat. Disord. 56, 27–32 (2018).
- 13. Pain in Parkinson's disease: a cross-sectional study of its prevalence, types, and relationship to depression and quality of life. PLoS ONE 10(8), e0136541 (2015).
- 14. . Pains in Parkinson disease – many syndromes under one umbrella. Nat. Rev. Neurol. 8(5), 284–294 (2012).
- 15. Muscular pain in Parkinson's disease and nociceptive processing assessed with CO2 laser-evoked potentials. Mov. Disord. 25(2), 213–220 (2010).
- 16. . Parkinson disease and musculoskeletal pain: an 8-year population-based cohort study. Pain 158(7), 1234–1240 (2017).
- 17. . Musculoskeletal problems in Parkinson's disease: neglected issues. Parkinsonism Relat. Disord. 19(7), 666–669 (2013).
- 18. Neck and shoulder pain in 70- to 79-year-old men and women: findings from the Health, Aging and Body Composition Study. Spine J. Off. J. North Am. Spine Soc. 3(6), 435–441 (2003).
- 19. Musculoskeletal disability among elderly people in the community. Med. J. Aust. 168(9), 439–442 (1998).
- 20. . Neck pain in the general population. Spine 19(12), 1307–1309 (1994).
- 21. . Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin. Proc. 90(2), 284–299 (2015).
- 22. The correlation of radiographic findings and patient symptomatology in cervical degenerative joint disease: a cross-sectional study. Chiropr. Man. Ther. 23, 9 (2015).
- 23. . The impact of multisite pain on functional outcomes in older adults: biopsychosocial considerations. J. Pain Res. 12, 1115–1125 (2019).
- 24. . Clinical factors associated with abnormal postures in Parkinson's disease. PLoS ONE 8(9), e73547 (2013).
- 25. The effect of postural deformities on back function and pain in patients with Parkinson's disease. NeuroRehabilitation 44(3), 419–424 (2019).
- 26. . The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Curr. Rev. Musculoskelet. Med. 12(4), 562–577 (2019).
- 27. . Age-related cutoffs for cervical movement behaviour to distinguish chronic idiopathic neck pain patients from unimpaired subjects. Eur. Spine J. 24(3), 493–502 (2015).
- 28. . Depression and Parkinson's disease: current knowledge. Curr. Neurol. Neurosci. Rep. 13(12), 409 (2013).
- 29. . Prevalence, determinants, and consequences of chronic neck pain in Finland. Am. J. Epidemiol. 134(11), 1356–1367 (1991).
- 30. . Investigation of clinically important benefit of anterior cervical decompression and fusion. Eur. Spine J. 16(4), 507–514 (2007).
- 31. . Anterior cervical decompression and fusion on neck range of motion, pain, and function: a prospective analysis. Spine J. Off. J. North Am. Spine Soc. 13(11), 1650–1658 (2013).
- 32. Patients with Parkinson disease experience increased perioperative complications following cervical decompression and fusion: a retrospective review of the national inpatient sample. World Neurosurg. 132, e463–e471 (2019).
- 33. . Shoulder pain in Parkinson's disease: a case-control study. Mov. Disord. 25(8), 1105–1106 (2010).
- 34. Shoulder symptoms and function in geriatric patients. J. Geriatr. Phys. Ther. 37(4), 154–158 (2014).
- 35. . Frozen shoulder and other shoulder disturbances in Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 52(1), 63–66 (1989).
- 36. . Shoulder pain: a presenting symptom of Parkinson disease. J. Clin. Rheumatol. 14(4), 253–254 (2008). • This brief letter to the editor describes how shoulder pain can be a presenting symptom of PD and reiterates the importance of screening for pain symptoms.
- 37. . Frozen shoulder and other shoulder disturbancies in Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 52(6), 813–814 (1989).
- 38. . Shoulder conditions: glenohumeral joint osteoarthritis and adhesive capsulitis. FP Essent. 491, 17–21 (2020).
- 39. . Magnetic resonance imaging findings of shoulders in Parkinson's disease. Mov. Disord. Off. J. Mov. Disord. Soc. 25(15), 2524–2530 (2010).
- 40. Ultrasonographic findings of shoulder disorders in patients with Parkinson's disease. Mov. Disord. 23(12), 1772–1776 (2008).
- 41. . Rotator cuff repair in patients over 70 years of age: early outcomes and risk factors associated with re-tear. Bone Jt J. 95-B(2), 199–205 (2013).
- 42. Rotator cuff tears after 70 years of age: a prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients. Orthop. Traumatol. Surg. Res. 99(Suppl. 8), S371–S378 (2013).
- 43. . Arthroscopic rotator cuff repair in patients older than 60 years. Arthroscopy 21(1), 48–54 (2005).
- 44. . Rotator cuff repairs in patients 62 years of age or older. J. Shoulder Elbow Surg. 10(2), 97–99 (2001).
- 45. Outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older. Arthroscopy 26(10), 1273–1280 (2010).
- 46. . Arthroscopic repair of full-thickness rotator cuff tears: is there tendon healing in patients aged 65 years or older? Arthroscopy 26(3), 302–309 (2010).
- 47. . Repair of massive rotator cuff tears in patients older than 70 years. J. Shoulder Elbow Surg. 8(1), 26–30 (1999).
- 48. . Total shoulder arthroplasty in patients with Parkinson's disease. J. Shoulder Elbow Surg. 6(1), 24–28 (1997).
- 49. . Outcome of reverse shoulder arthroplasty for patients with Parkinson's disease: a matched cohort study. Orthopedics 40(4), e675–e680 (2017).
- 50. . Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J. Shoulder Elbow Surg. 15(5), 527–540 (2006).
- 51. Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older. Int. Orthop. 44(6), 1131–1141 (2020).
- 52. . Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy. Cochrane Database Syst. Rev. 4, CD012879 (2020).
- 53. . Physiotherapy interventions for shoulder pain. Cochrane Database Syst. Rev. (2),
doi:10.1002/14651858.CD004258 (2003). - 54. . Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum. 59(5), 615–622 (2008).
- 55. . How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey. J. Fam. Pract. 51(4), 345–348 (2002).
- 56. . Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum. 38(8), 1134–1141 (1995).
- 57. . Epidemiology of hip fractures: implications of the exponential increase with age. Bone 18(Suppl. 3), S121–S125 (1996).
- 58. Fracture risk after the diagnosis of Parkinson's disease: influence of concomitant dementia. Mov. Disord. Off. J. Mov. Disord. Soc. 21(9), 1361–1367 (2006).
- 59. Frontal plane kinematics in walking with moderate hip osteoarthritis: stability and fall risk. Clin. Biomech. Bristol Avon. 30(8), 874–880 (2015).
- 60. . Hip Symptoms, physical performance, and health status in older adults with chronic low back pain: a preliminary investigation. Arch. Phys. Med. Rehabil. 99(7), 1273–1278 (2018).
- 61. . Hip osteoarthritis signs and symptoms are associated with increased fall risk among community-dwelling older adults with chronic low back pain: a prospective study. Arthritis Res. Ther. 23(1), 71 (2021).
- 62. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. (Hoboken) 72(2), 220–233 (2020).
- 63. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann. Rheum. Dis. 72(7), 1125–1135 (2013).
- 64. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 27(11), 1578–1589 (2019).
- 65. . Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA 325(6), 568–578 (2021).
- 66. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database Syst. Rev. 4, CD010842 (2018).
- 67. The role of physical activity as conservative treatment for hip and knee osteoarthritis in older people: a systematic review and meta-analysis. J. Clin. Med. 9(4), 1167(2020).
- 68. . Total hip arthroplasty in Parkinson's disease – a systematic review of the current evidence. J. Orthop. 24, 284–290 (2021).
- 69. Does Parkinson disease increase the risk of perioperative complications after total hip arthroplasty? A Nationwide Database Study. J. Arthroplasty 33(7S), S162–S166 (2018).
- 70. . Risk factors for early dislocation following primary elective total hip arthroplasty. J. Arthroplasty 33(5), 1567–1571.e2 (2018).
- 71. . Matched cohort analysis of total hip arthroplasty in patients with and without Parkinson's disease: complications, mortality, length of stay, and hospital charges. J. Arthroplasty 34(7S), S228–S231 (2019).
- 72. . Is Parkinson's disease associated with increased mortality, poorer outcomes scores, and revision risk after THA? Findings from the Swedish Hip Arthroplasty Register. Clin. Orthop. 477(6), 1347–1355 (2019).
- 73. . Total joint arthroplasty in patients with Parkinson's disease: survivorship, outcomes, and reasons for failure. J. Arthroplasty. 33(4), 1028–1032 (2018). • Details the outcomes after total knee arthroplasty for individuals in PD and demonstrates the poorer outcomes after total knee arthroplasty.
- 74. . The outcomes of total hip replacement in patients with Parkinson's disease: comparison of the elective and hip fracture groups. Park. Dis. 2017, 1597463 (2017).
- 75. Musculoskeletal pain and deformities in Parkinson's disease. Int. J. Clin. Exp. Med. 9(7), 14663–14669 (2016).
- 76. . The influence of knee pain location on symptoms, functional status, and knee-related quality of life in older adults with chronic knee pain: data from the osteoarthritis initiative. Clin. J. Pain 32(6), 463–470 (2016).
- 77. A longitudinal study of knee pain in older men: Concord Health and Ageing in Men Project. Age Ageing 43(2), 206–212 (2014).
- 78. . Modifiers of change in physical functioning in older adults with knee pain: the Observational Arthritis Study in Seniors (OASIS). Arthritis Rheum. 45(4), 331–339 (2001).
- 79. Predicting the course of functional limitation among older adults with knee pain: do local signs, symptoms and radiographs add anything to general indicators? Ann. Rheum. Dis. 67(10), 1390–1398 (2008).
- 80. . Predictors of pain severity trajectory in older adults: a 10.7-year follow-up study. Osteoarthritis Cartilage 26(12), 1619–1626 (2018).
- 81. . Outcomes of primary total knee arthroplasty in patients with Parkinson's Disease. J. Arthroplasty 33(6), 1745–1748 (2018).
- 82. . Surgical outcomes of primary hip and knee replacements in patients with Parkinson's disease: a nationwide registry-based case-controlled study. Bone Jt J. 96-b(4), 486–491 (2014).
- 83. . Functional outcomes after total joint arthroplasty are related to the severity of Parkinson's disease: a mid-term follow-up. J. Orthop. Surg. Res. 14(1), 396 (2019).
- 84. . Total knee arthroplasty in patients with Parkinson's disease. J. Arthroplasty 11(8), 899–904 (1996).
- 85. Unicompartmental knee arthroplasty in patients with Parkinson's disease. Knee 27(5), 1325–1331 (2020).
- 86. . Patients with Parkinson's disease have poorer function and more flexion contractures after total knee arthroplasty. J. Arthroplasty 36(7), 2325–2330 (2020).
- 87. . Do we really improve life quality after total knee arthroplasty in patients with Parkinson's disease? Arch. Orthop. Trauma Surg. 141(2), 313–319 (2021).
- 88. . Total knee arthroplasty in the patient with Parkinson's disease. J. Bone Joint Surg. Br. 71(1), 51–54 (1989).
- 89. . Total knee arthroplasty in patients with Parkinson's disease: impact of early postoperative neurologic intervention. Am. J. Orthop. Belle Mead NJ 37(10), 513–516 (2008).
- 90. . The relative health related quality of life of veterans with Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 74(2), 163–169 (2003).
- 91. . The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson's disease: implications on spinal surgery. Eur. Spine J. 27(11), 2847–2853 (2018).
- 92. . Radicular and nonradicular back pain in Parkinson's disease: a controlled study. Mov. Disord. Off. J. Mov. Disord. Soc. 22(6), 853–856 (2007).
- 93. Back problems in Parkinson's disease: an underestimated problem. Joint Bone Spine 73(3), 298–302 (2006).
- 94. . Musculoskeletal problems in Parkinson's disease: neglected issues. Parkinsonism Relat. Disord. 19(7), 666–669 (2013).
- 95. . Predictive risk factors for chronic low back pain in Parkinson's disease. Clin. Neurol. Neurosurg. 164, 190–195 (2018).
- 96. . Gender differences in Parkinson's disease symptom profile. Acta Neurol. Scand. 102(1), 37–43 (2000).
- 97. Characteristics and exacerbating factors of chronic low back pain in Parkinson's disease. Int. Orthop. 39(12), 2433–2438 (2015).
- 98. . Low back pain – related disability in Parkinson disease: impact on functional mobility, physical activity, and quality of life. Phys. Ther. 99(10), 1346–1353 (2019).
- 99. . Low back pain in Parkinson's disease: a cross-sectional study of its prevalence, and implications on functional capacity and quality of life. Clin. Neurol. Neurosurg. 194, 105787 (2020).
- 100. . Paradigm shift in geriatric low back pain management: integrating influences, experiences, and consequences. Phys. Ther. 98(5), 434–446 (2018). •• This comprehensive review details what is known about the multi-factorial nature of low back pain in older adults.
- 101. . Trunk muscle characteristics of the multifidi, erector spinae, psoas, and quadratus lumborum in older adults with and without chronic low back pain. J. Orthop. Sports Phys. Ther. 47(3), 173–179 (2017).
- 102. Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. J. Gerontol. A. Biol. Sci. Med. Sci. 60(7), 882–887 (2005).
- 103. . Lumbar mobility and performance-based function: an investigation in older adults with and without chronic low back pain. Pain Med. Malden Mass 18(1), 161–168 (2017).
- 104. . Back stiffness is associated with physical health and low back pain-related disability in community-dwelling older adults. Pain Med. Malden Mass 18(5), 866–870 (2017).
- 105. . Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait Posture 55, 172–176 (2017).
- 106. Postural responses to a suddenly released pulling force in older adults with chronic low back pain: an experimental study. PLoS ONE 11(9), e0162187 (2016).
- 107. . The impact of chronic low back pain on older adults: a comparative study of patients and controls. Pain 131(3), 293–301 (2007).
- 108. . The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain. Pain Med. Malden Mass. 7(1), 60–70 (2006).
- 109. . Fear-avoidance beliefs are associated with disability in older American adults with low back pain. Phys. Ther. 91(4), 525–534 (2011).
- 110. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J. Am. Geriatr. Soc. 50(Suppl. 6), S205–S224 (2002).
- 111. . Effects of safinamide on pain in fluctuating Parkinson's disease patients: a post-hoc analysis. J. Park. Dis. 7(1), 95–101 (2017).
- 112. A randomized controlled exploratory pilot study to evaluate the effect of rotigotine transdermal patch on Parkinson's disease-associated chronic pain. J. Clin. Pharmacol. 56(7), 852–861 (2016).
- 113. Chronic subthalamic deep brain stimulation improves pain in Parkinson disease. J. Neurol. 255(12), 1889–1894 (2008).
- 114. Prolonged-release oxycodone-naloxone for treatment of severe pain in patients with Parkinson's disease (PANDA): a double-blind, randomised, placebo-controlled trial. Lancet Neurol. 14(12), 1161–1170 (2015).
- 115. Lumbar spine surgery in patients with Parkinson Disease. J. Bone Joint Surg. Am. 97(20), 1661–1666 (2015).
- 116. . To operate or not? A literature review of surgical outcomes in 95 patients with Parkinson's disease undergoing spine surgery. Clin. Neurol. Neurosurg. 134, 122–125 (2015).
- 117. Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study. Spine J. Off. J. North Am. Spine Soc. 17(4), 531–537 (2017).
- 118. . Spinal surgery in patients with Parkinson's disease: construct failure and progressive deformity. Spine 29(18), 2006–2012 (2004).
- 119. Yoga improves balance and low-back pain, but not anxiety, in people with Parkinson's Disease. Int. J. Yoga Ther. 30(1), 41–48 (2020).
- 120. . Trunk muscle training augmented with neuromuscular electrical stimulation appears to improve function in older adults with chronic low back pain: a randomized preliminary trial. Clin. J. Pain 32(10), 898–906 (2016).
- 121. Pain in Parkinson's disease: facts and uncertainties. Eur. J. Neurol. 25(7), 917–e969 (2018). •• This paper is a comprehensive review of the pathophysiologic underpinnings of pain in people with PD.
- 122. . How pain arises in Parkinson's disease? Eur. J. Neurol. 20(12), 1517–1523 (2013).
- 123. . Consistency of a lumbar movement pattern across functional activities in people with low back pain. Clin. Biomech. Bristol Avon. 44, 45–51 (2017).
- 124. . Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis. J. Biomech. 94, 123–129 (2019).
- 125. . Age-related differences in sagittal-plane knee function at heel-strike of walking are increased in osteoarthritic patients. Osteoarthritis Cartilage 22(3), 464–471 (2014).
- 126. . The association of scapular kinematics and glenohumeral joint pathologies. J. Orthop. Sports Phys. Ther. 39(2), 90–104 (2009).
- 127. . Tissue adaptation to physical stress: a proposed ‘Physical Stress Theory' to guide physical therapist practice, education, and research. Phys. Ther. 82(4), 383–403 (2002).
- 128. Physical inactivity in Parkinson's disease. J. Neurol. 258(12), 2214–2221 (2011).
- 129. . Postoperative complications in Parkinson's disease. J. Am. Geriatr. Soc. 47(8), 967–972 (1999).
- 130. . An integrated review of psychological stress in Parkinson's disease: biological mechanisms and symptom and health outcomes. Park. Dis. 2016, 9869712 (2016).
- 131. Orthopedic surgery and post-operative cognitive decline in idiopathic Parkinson's disease: considerations from a pilot study. J. Park. Dis. 5(4), 893–905 (2015).
- 132. Chronic postsurgical pain in Europe: an observational study. Eur. J. Anaesthesiol. 32(10), 725–734 (2015).
- 133. . Pain intensity on and off levodopa in patients with Parkinson's disease. Mov. Disord. Off. J. Mov. Disord. Soc. 24(8), 1233–1237 (2009).
- 134. Effects of deep brain stimulation on pain and other nonmotor symptoms in Parkinson disease. Neurology 83(16), 1403–1409 (2014).