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February 2009

Central Pain and Parkinson Disease—Reply

Arch Neurol. 2009;66(2):280-285. doi:10.1001/archneurol.2008.553

In reply

We thank Dr Canavero for his comments on our case-control study on pain in PD. Our findings suggested that both dystonic pain and nondystonic pain (ie, pain that is not associated with visible dystonia) starting at PD onset or thereafter may be more frequent in patients with PD than in control subjects. Given that nondystonic painful states may be heterogeneous in PD, we also checked whether specific subtypes of nondystonic pain could be unrelated to the motor signs of PD, hence identifiable as nonmotor features of PD. To this aim, we referred to the international classification of chronic pain.1 We agree with Dr Canavero that this classification may have limitations. Nevertheless, it is a widely accepted classification system allowing for comparisons with previous studies and daily clinical practice. Applying this classification, we observed that primary central neuropathic pain and muscle cramping pain were associated with PD, whereas peripheral neuropathic pain and arthralgic pain were not.