Subthalamic nucleus stimulation for attenuation of pain related to Parkinson disease

Clinical article

Restricted access

Object

The objective of this study was to evaluate the efficacy of chronic subthalamic nucleus (STN) stimulation for alleviating pain related to Parkinson disease (PD).

Methods

Among 163 consecutive patients undergoing STN stimulation, 69 were identified as experiencing pain preoperatively that was related to their PD. All 69 patients suffering from pain were followed up prospectively for 12 months after surgery. All patients described the severity of their pain according to a visual analog scale (VAS) preoperatively and at 2 weeks, 6 months, and 12 months postoperatively. Pain unrelated to PD was not studied.

Results

Several types of pain related to PD, the categories of which were based on a modification of 2 previous classifications (Ford and Honey), can occur in such patients: 1) musculoskeletal pain, 2) dystonic pain, 3) somatic pain exacerbated by PD, 4) radicular/peripheral neuropathic pain, and 5) central pain. The overall mean VAS score was significantly decreased postoperatively by 75% and 69% at 2 weeks and 6 months, respectively (p < 0.001). The mean VAS score at 12 months was also decreased by 80%, but 6 instances of pain (3 reports of somatic back pain and 3 reports of radicular/peripheral neuropathic pain) required additional spinal surgery to alleviate the pain severity. The results were analyzed using the Wilcoxon signed-rank test and demonstrated a significant reduction in VAS scores at all follow-up assessments (p < 0.001). Musculoskeletal pain and dystonic pain were well alleviated by STN stimulation. In contrast, somatic pain exacerbated by PD and peripheral neuropathic pain originating from lumbar spinal diseases, such as spondylosis deformans and/or canal stenosis, often deteriorated postoperatively despite attenuation of the patients' motor disability. Patients with central pain were poor responders.

Conclusions

This study found that STN stimulation produced significant improvement of overall pain related to PD in patients with advanced PD, and the efficacy continued for at least 1 year. The present results indicate that musculoskeletal pain and dystonic pain responded well to STN stimulation, but patients with back pain (somatic pain) and radicular/peripheral neuropathic pain originating from spinal disease have a potential risk for postoperative deterioration of their pain.

Abbreviations used in this paper: DBS = deep brain stimulation; PD = Parkinson disease; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale; VAS = visual analog scale.
Article Information

Contributor Notes

Address correspondence to: Chikashi Fukaya, M.D., Ph.D., Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan. email: fukaya.chikashi@nihon-u.ac.jp.Please include this information when citing this paper: published online September 9, 2011; DOI: 10.3171/2011.7.JNS11158.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Baron MSVitek JLBakay RAGreen JKaneoke YHashimoto T: Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann Neurol 40:3553661996

    • Search Google Scholar
    • Export Citation
  • 2

    Barone PAntonini AColosimo CMarconi RMorgante LAvarello TP: The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Mov Disord 24:164116492009

    • Search Google Scholar
    • Export Citation
  • 3

    Beiske AGLoge JHRønningen ASvensson E: Pain in Parkinson's disease: prevalence and characteristics. Pain 141:1731772009

  • 4

    Brefel-Courbon CPayoux PThalamas COry FQuelven IChollet F: Effect of levodopa on pain threshold in Parkinson's disease: a clinical and positron emission tomography study. Mov Disord 20:155715632005

    • Search Google Scholar
    • Export Citation
  • 5

    Broetz DEichner MGasser TWeller MSteinbach JP: Radicular and nonradicular back pain in Parkinson's disease: a controlled study. Mov Disord 22:8538562007

    • Search Google Scholar
    • Export Citation
  • 6

    Burchiel KJAnderson VCFavre JHammerstad JP: Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: results of a randomized, blinded pilot study. Neurosurgery 45:137513841999

    • Search Google Scholar
    • Export Citation
  • 7

    Canavero S: Central pain and Parkinson disease. Arch Neurol 66:2822832009

  • 8

    Chudler EHDong WK: The role of the basal ganglia in nociception and pain. Pain 60:3381995

  • 9

    Deep-Brain Stimulation for Parkinson's Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:9569632001

    • Search Google Scholar
    • Export Citation
  • 10

    Defazio GBerardelli AFabbrini GMartino DFincati EFiaschi A: Pain as a nonmotor symptom of Parkinson disease: evidence from a case-control study. Arch Neurol 65:119111942008

    • Search Google Scholar
    • Export Citation
  • 11

    Djaldetti RShifrin ARogowski ZSprecher EMelamed EYarnitsky D: Quantitative measurement of pain sensation in patients with Parkinson disease. Neurology 62:217121752004

    • Search Google Scholar
    • Export Citation
  • 12

    Ford B: Pain in Parkinson's disease. Clin Neurosci 5:63721998

  • 13

    Gerdelat-Mas ASimonetta-Moreau MThalamas COry-Magne FSlaoui TRascol O: Levodopa raises objective pain threshold in Parkinson's disease: a RIII reflex study. J Neurol Neurosurg Psychiatry 78:114011422007

    • Search Google Scholar
    • Export Citation
  • 14

    Giuffrida RVingerhoets FJBogousslavsky JGhika J: [Pain in Parkinson's disease.]. Rev Neurol (Paris) 161:4074182005. (Fr)

  • 15

    Goetz CGTanner CMLevy MWilson RSGarron DC: Pain in Parkinson's disease. Mov Disord 1:45491986

  • 16

    Honey CRStoessl AJTsui JKSchulzer MCalne DB: Unilateral pallidotomy for reduction of parkinsonian pain. J Neurosurg 91:1982011999

    • Search Google Scholar
    • Export Citation
  • 17

    Katayama YKasai MOshima HFukaya CYamamoto TOgawa K: Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients. J Neurosurg 95:2132212001

    • Search Google Scholar
    • Export Citation
  • 18

    Kim HJPaek SHKim JYLee JYLim YHKim MR: Chronic subthalamic deep brain stimulation improves pain in Parkinson disease. J Neurol 255:188918942008

    • Search Google Scholar
    • Export Citation
  • 19

    Koller WC: Sensory symptoms in Parkinson's disease. Neurology 34:9579591984

  • 20

    Krack PBatir AVan Blercom NChabardes SFraix VArdouin C: Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349:192519342003

    • Search Google Scholar
    • Export Citation
  • 21

    Krack PPollak PLimousin PBenazzouz ADeuschl GBenabid AL: From off-period dystonia to peak-dose chorea. The clinical spectrum of varying subthalamic nucleus activity. Brain 122:113311461999

    • Search Google Scholar
    • Export Citation
  • 22

    Kumar RLozano AMKim YJHutchison WDSime EHalket E: Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 51:8508551998

    • Search Google Scholar
    • Export Citation
  • 23

    Laitinen LVBergenheim ATHariz MI: Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 76:53611992

    • Search Google Scholar
    • Export Citation
  • 24

    Lee MAWalker RWHildreth TJPrentice WM: A survey of pain in idiopathic Parkinson's disease. J Pain Symptom Manage 32:4624692006

    • Search Google Scholar
    • Export Citation
  • 25

    Limousin PKrack PPollak PBenazzouz AArdouin CHoffmann D: Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 339:110511111998

    • Search Google Scholar
    • Export Citation
  • 26

    Loher TJBurgunder JMWeber SSommerhalder RKrauss JK: Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 73:3953992002

    • Search Google Scholar
    • Export Citation
  • 27

    Nègre-Pagès LRegragui WBouhassira DGrandjean HRascol O: Chronic pain in Parkinson's disease: the cross-sectional French DoPaMiP survey. Mov Disord 23:136113692008

    • Search Google Scholar
    • Export Citation
  • 28

    Quinn NPKoller WCLang AEMarsden CD: Painful Parkinson's disease. Lancet 1:136613691986

  • 29

    Sage JIKortis HISommer W: Evidence for the role of spinal cord systems in Parkinson's disease-associated pain. Clin Neuropharmacol 13:1711741990

    • Search Google Scholar
    • Export Citation
  • 30

    Snider SRFahn SIsgreen WPCote LJ: Primary sensory symptoms in parkinsonism. Neurology 26:4234291976

  • 31

    Task Force on Taxonomy of the International Association for the Study of PainRelatively generalized syndromes: central pain. Merskey HBogduk N: Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms ed 2Seattle, WAIASP Press1994. 4344

    • Search Google Scholar
    • Export Citation
  • 32

    Tinazzi MDel Vesco CDefazio GFincati ESmania NMoretto G: Abnormal processing of the nociceptive input in Parkinson's disease: a study with CO2 laser evoked potentials. Pain 136:1171242008

    • Search Google Scholar
    • Export Citation
  • 33

    Tinazzi MDel Vesco CFincati EOttaviani SSmania NMoretto G: Pain and motor complication in Parkinson's disease. J Neurol Neurosurg Psychiatry 77:8228252009

    • Search Google Scholar
    • Export Citation
  • 34

    Witjas TKaphan ERégis JJouve EChérif AAPéragut JC: Effects of chronic subthalamic stimulation on nonmotor fluctuations in Parkinson's disease. Mov Disord 22:172917342007

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 159 150 6
Full Text Views 144 66 1
PDF Downloads 110 53 1
EPUB Downloads 0 0 0
PubMed
Google Scholar