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Original Contribution
September 2008

Pain as a Nonmotor Symptom of Parkinson Disease: Evidence From a Case-Control Study

Author Affiliations

Author Affiliations: Department of Neurology and Psychiatry, University of Bari, Bari, Italy (Drs Defazio, Martino, and Lamberti); Department of Neurology and Institute NEUROMED, Sapienza University of Rome, Rome, Italy (Drs Berardelli and Fabbrini); Departments of Neurology and Ophthalmology, University of Verona (Drs Fincati, Fiaschi, and Tinazzi), and Neurology Unit OCM (Drs Moretto and Tinazzi), Verona, Italy; Departments of Neurology, University of Genoa, Genoa, Italy (Drs Abbruzzese and Marchese); University of Pisa, Pisa, Italy (Drs Bonuccelli and Del Dotto); and University of Naples, Naples, Italy (Drs Barone and De Vivo); Fondazione Institute of Neurology “Carlo Besta” Foundation (Dr Albanese), and Parkinson's Disease Center, “Istituti Clinici di Perfezionamento” (Drs Antonini and Canesi), Milan, Italy; Department of Neurology, University of Turin, Turin, Italy (Drs Lopiano and Zibetti); and Institute of Neurology, “C. Mondino” Foundation, University of Pavia, Pavia, Italy (Drs Nappi and Martignoni).

Arch Neurol. 2008;65(9):1191-1194. doi:10.1001/archneurol.2008.2

Objective  To determine whether pain is more frequent among people with Parkinson disease (PD) than among age-matched controls.

Design  Case-control study.

Patients and Methods  Logistic regression models taking into account type of pain, time between pain and PD onset, and possible confounders were used to compare 402 PD patients with 317 age-matched healthy control subjects.

Results  The overall frequency of pain was significantly greater in PD patients than in controls (281 [69.9%] vs 199 [62.8%]; P = .04), mainly because the healthy control group lacked dystonic pain. Conversely, the frequency of nondystonic pain was similar among PD patients and controls (267 [66.4%] vs 199 [62.8%]; P = .28). Nevertheless, we observed a significant association between PD and nondystonic pain, beginning after the onset of parkinsonian symptoms (odds ratio, 2.1; 95% confidence interval, 1.4-2.9). Cramping and central neuropathic pain were more frequent among PD patients than controls. About one-quarter of patients who experienced pain reported pain onset before starting antiparkinsonian therapy.

Conclusion  These data support the hypothesis that pain begins at clinical onset of PD or thereafter as a nonmotor feature of PD.