Clinical Characteristics of Pain in Patients with Parkinson’s Disease Who Have Visited a Korean Medical Hospital : A Retrospective Chart Review

Hye-Seon Jeong; Ha-Ri Kim; Seo-Yung Kim; Tae-Bin Yim; Chul Jin; Seung-Won Kwon; Seung-Yeon Cho; Woo-Sang Jung; Sang-Kwan Moon; Jung-Mi Park; Chang-Nam Ko; Seong-Uk Park; Jeong, Hye-Seon; Kim, Ha-Ri; Kim, Seo-Yung; Yim, Tae-Bin; Jin, Chul; Kwon, Seung-Won; Cho, Seung-Yeon; Jung, Woo-Sang; Moon, Sang-Kwan; Park, Jung-Mi; Ko, Chang-Nam; Park, Seong-Uk

doi:10.13048/jkm.20012

JKM > Volume 41(2); 2020 > Article

Jeong, Kim, Kim, Yim, Jin, Kwon, Cho, Jung, Moon, Park, Ko, and Park: Clinical Characteristics of Pain in Patients with Parkinson’s Disease Who Have Visited a Korean Medical Hospital: A Retrospective Chart Review

Original Article

The Journal of Korean Medicine 2020; 41(2): 23-33.

Published online: June 1, 2020

DOI: https://doi.org/10.13048/jkm.20012

Clinical Characteristics of Pain in Patients with Parkinson’s Disease Who Have Visited a Korean Medical Hospital: A Retrospective Chart Review

Hye-Seon Jeong¹^{, 2}

, Ha-Ri Kim²

, Seo-Yung Kim²

, Tae-Bin Yim²

, Chul Jin²

, Seung-Won Kwon²^{, 3}

, Seung-Yeon Cho¹^{, 2}^{, 3}

, Woo-Sang Jung²^{, 3}

, Sang-Kwan Moon²^{, 3}

, Jung-Mi Park¹^{, 2}^{, 3}

, Chang-Nam Ko¹^{, 2}^{, 3}

, Seong-Uk Park¹^{, 2}^{, 3}^{, *}

¹Stroke and Neurological Disorders Center, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Korea

²Department of Cardiology and Neurology of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea

³Department of Cardiology and Neurology of College of Korean Medicine, Kyung Hee University, Seoul, Korea

Correspondence to：박성욱 서울시 강동구 동남로 892 강동경희대학교병원 뇌신경센터 한방내과, Tel: +82-2-440-6217, Fax: +8-440-7171, E-mail: seonguk.kr@gmail.com

Received April 7, 2020 Revised May 19, 2020 Accepted May 21, 2020

Abstract

Objectives

To investigate the prevalence of pain, clinical characteristics of pain, association between clinical features and pain of patients with Parkinson’s Disease(PD).

Methods

We undertook a retrospective review of the medical records of patients diagnosed with PD between 2012 and 2019 at Kyung Hee University Korean Medicine Hospital at Gangdong in South Korea.

Results

A total of 172 PD patients met entry criteria and 147 out of 172 patients(85.5%) reported pain. In comparison with general population, PD patients has high prevalence of pain. Female PD patients more frequently reported pain than male (P=0.03). 102 out of 147patients(69.3) complained of musculoskeletal pain, and musculoskeletal pain show significant difference depending on the PD motor subtypes (P=0.039). Pain was mainly locatedin the leg (57.8%) in all PD motor subtypes. Tremor-dominant PD more frequently felt pain in upper limb than postural instability-gait difficulty dominant(PIGD) PD, but it was not statistically significant.

Conclusions

These findings showed high prevalence of pain in PD patients, the correlation between female and pain, and the relationship between PD motor subtype and pain type. Our study can contribute to the clinical approach based on a more in-depth understanding of PD patients with pain.

Keywords: Pain, Parkinson’s disease, Pain prevalence, Pain characteristics

Fig. 1

A Flow Chart of our study

PD: Parkinson’s Disease, HY: Hoehn and Yahr, UPDRS: The unified Parkinson’s disease rating scale

Fig. 2

Number of pain types in Parkinson’s Disease Patients.

Different pain types often coexist in the one patient. According to Ford’s pain type, there are five types- musculoskeletal, radicular/ neuropathic, dystonic, central, other- of pain. When analyzing the types of pain in one person, 38.1% of PD patient have 2 types of pain. More than two-thirds of patient have two or more types of pain.

Table 1

General and Clinical Characteristics of Patients

Characteristics	Total
Number	172

Gender, n(%)	77(44.8)
Male	95(55.2)
Female	77(44.8)

PD subtype†, n(%)
PIGD type	98(56.9)
TD type	67(39.0)
ID type	7(4.1)

Hoehn and Yahr stage, n(%)
HY stage 1	89(51.7)
HY stage 2	46(26.7)
HY stage 3	26(15.1)
HY stage 4	8(4.7)
HY stage 5	3(1.7)

Median Hoehn and Yahr stage^a	1.8±1.0

UPDRS^a	9.3±6.6
Part 2	9.3±6.6
Part 3	14.3±10.6

Pain prevalence, n(%)	147(85.3)

Independent t–test was used to compare age of onset between PD subtypes. Mann–Whitney U test was used to compare time from first symptom to diagnosis in years between PD subtypes.

* P<0.05wasconsideredtobesignificant.

* Shown as mean±SD,

† PD motor subtype.

PD: Parkinson’s Disease; HY: Hoehn and Yahr; UPDRS: The unified Parkinson’s disease rating scale; PIGD = Postural instability-gait difficulty dorminan;, TD = Tremor dorminant

Table 2

Correlation between Parkinson’s Disease Subtype and Age

Characteristics	Total	P-value
Agea — yr
Age in years	66.3±9.9
Age of onset	60.9±10.4
PIGD type	62.0±11.0	0.048*
TD type	58.7±9.1	0.048*

Age at diagnosed with PD	61.5±10.3

Duration of disease^a	6.3±3.8

Time from first symptom to diagnosis in years^a	0.5±1.1
PIGD type	1.1±1.5	0.002*
TD type	0.6±1.2	0.002*

Independent t-test was used to compare age of onset between PD subtypes. Mann–Whitney U test was used to compare time from first symptom to diagnosis between PD subtypes.

* P<0.05was considered to be significant.

† Shown as mean±SD

PD: Parkinson’s Disease; HY: Hoehn and Yahr; PIGD = Postural instability-gait difficulty dorminant; TD = Tremor dorminant

Table 3

Correlation between Pain and General Characteristics in Parkinson’s Disease

Characteristics	PD without pain (N=23)	PD with pain (N=147)	p-value
Gender, n(%)
Female	9(36)	86(58.3)	0.036*
Male	16(64)	61(41.3)	0.036*

Age in year^a	64.3±11.7	66.6±9.6	0.243

Age of onset^a	59.1±11.1	62.26±10.31	0.080

Age at diagnosed† with PD	59.9±11.3	61.7±10.1	0.235

Duration of disease^a	6.3±3.8	6.2±3.4	0.951

Time from first smptom to diagnosis in years^a	0.5±1.0	0.8±1.7	0.925

Data analysed by descriptive statistics. Correlation between data analysed by chi square test. PD = Parkinson’s disease,

* P<0.05was considered to be significant.

† Shown as mean±SD

‡ Time when the patient diagnosed at the time of initial stage

Table 4

Clinical Characteristics of Pain and Subtype in Parkinson’s Disease

	PD with pain (N=147)	PD stubtype(N=147)			p-value

		PIGD (N=83)	TD (N=57)	ID (N=3)
N	147	85	57	5	0.253

Type of Pain, n(%)†
Musculoskeletal Pain	102(69.3)	66(77.6)	33(57.8)	3(60.0)	0.039*
Radicular/Neuropathic Pain	58(39.4)	30(35.3)	26(45.6)	2(40.0)	0.531
Dystonic Pain	47(32.0)	27(31.8)	18(31.6)	2(40.0)	0.992
Central Pain	41(27.9)	25(29.4)	14(24.6)	2(40.0)	0.774
Other pain	45(30.6)	31(36.3)	13(22.8)	1(20.0)	0.184

Region, n(%)
Head	22(15.0)	16	5	1	0.238
Jaw	6(4.1)	3	2	1	0.287
Neck	18(12.2)	12	6	0	0.555
Shoulder	36(24.3)	16	18	2	0.184
Arm	22(15.0)	9	12	1	0.186
Hand	13(9.3)	7	6	0	0.868
Abdomen	17(11.6)	13	5	0	0.377
Back	51(34.7)	33	17	1	0.435
Hip	30(20.4)	17	12	1	0.961
Leg	84(57.8)	50	31	4	0.829
Foot	40(27.2)	25	14	1	0.708
Chest	14(9.3)	7	7	0	0.502

Data analsyed by chi square test. If the expected count less than 5, fisher’s exact test was done. Chi square test;

* P<0.05 was considered to be significant.

† N(%) shown as Number and proportion of PD subtype who have pain.

PIGD = Postural instability-gait difficulty dorminant type, TD = Tremor dorminant type, ID = Indetermined type

Appendix 1

Ford’s pain classification

Pain type	Pain features
Musculoskeletal pain	Aching, cramping, arthralgic, myalgic sensations in joints, and muscles
	Associated findings may include muscle tenderness, arthritic changes, skeletal deformity, limited joint mobility, postural abnormalities, and antalgic gait
	May be exacerbated by parkinsonian rigidity, stiffness, and immobility, and relieved by mobility
	May fluctuate with dose of medication and improves with levodopa
Radicular/neuropathic pain	Pain in a root or nerve territory, associated with motor or sensory signs of nerve or root entrapment
Dystonic pain	Associated with sustained twisting movements and postures; muscular contractions often very forceful and painful
Dystonic pain	May fluctuate closely with medication dosing: early morning dystonia, off dystonia, beginning-of-dose and end-of-dose dystonia, peak dose dystonia
Central or primary pain	Burning, tingling, formication, ““neuropathic”“ sensations, often relentless and bizarre in quality, not confined to root or nerve territory
	Pain may have an autonomic character, with visceral sensations or dyspnea, and vary in parallel with the medication cycle as a non-motor fluctuation
	Not explained by rigidity, dystonia, musculoskeletal or internal lesion
Other pain	Primary headache, visceral, arthritic, non-radicular low back pain, oral and genital pain
Note: in an original paper Ford proposed a 5th type of pain: ““akathitic discomfort”“⁵¹⁾;Valkovicetal,.substitutedthistypeintheirstudybycategory”“other pain”“13).

doi:10.1371/journal.pone.0136541.t002

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