On the diagnosis of pain in Parkinson disease : a mechanism-based approach

Abstract

Abstract: We read with interest the article entitled “Pain in the neurodegenerating brain: insights into pharmacotherapy for Alzheimer disease and Parkinson disease” from Timothy Lawn et al. Their review summarized the current findings on pain processing as well as on pharmacotherapy of pain in both diseases. It further emphasizes the importance of mechanistic research for evidence-based pain medicine. We would like to comment on the experimental findings and on the importance of a mechanism-based approach in Parkinson disease (PD) after the correct diagnosis of PDrelated pain has been made because a mechanism-based approach has been already validated. Concerning experimental pain sensitivity, studies revealed increased pain sensitivity when tested in the medication defined off phase, whereas converse observations were made in the on phase. Increased pain sensitivity can be reversed by L-dopa or deep brain stimulation.