Home | Register | Login | Inquiries | Alerts | Sitemap |  

Advanced Search
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



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


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.


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.


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.

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 stagea 1.8±1.0

UPDRSa 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

Age at diagnosed with PD 61.5±10.3

Duration of diseasea 6.3±3.8

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

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)

Age in yeara 64.3±11.7 66.6±9.6 0.243

Age of onseta 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 diseasea 6.3±3.8 6.2±3.4 0.951

Time from first smptom to diagnosis in yearsa 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
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).



1. Association of Korean Medicine Professors for Cardiovascular and Neurologic Medicine. Cardiovascular and Neurological Medicine in Korean Medicine 3. Seoul: WOORI Medical Books;2016. p. 113–114.

2. Gelb DJ, Oliver E, Gilman S. Diagnostic Criteria for Parkinson Disease. JAMA Neurol. 1999; 56:1. 33–39.

3. Buhmann C, Wrobel N, Grashorn W, et al. Pain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy. J Neurol. 2017; 264:4. 758–769.
crossref pmid

4. Broen MPG, Braaksma MM, Patijn J, Weber WEJ. Prevalence of pain in Parkinson’s disease: a systematic review using the modified QUADAS tool. Mov Disord. 2012; 27:4. 480–484.
crossref pmid

5. Zhang LM, Chen YQ, Li WJ, Sun W, Huang Y, Zou HQ. Association between mutations of SCN9A gene and pain related to Parkinsonism. Chinese J Med Genet. 2013; 30:1. 17–20.

6. Greenbaum L, Tegeder I, Barhum Y, Melamed E, Roditi Y, Djaldetti R. Contribution of genetic variants to pain susceptibility in Parkinson disease. Eur J Pain. 2012; 16:9. 1243–1250.
crossref pmid

7. Rukavina K, Leta V, Sportelli C, et al. Pain in Parkinson’s disease: New concepts in pathogenesis and treatment. Curr Opin Neurol. 2019; 32:4. 579–588.
crossref pmid

8. Trenkwalder C, Chaudhuri KR, Martinez MP, et al. Prolonged-release oxycodone-naloxone for treatment of severe pain in patients with Parkinson’s disease (PANDA): A double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2015; 14:12. 1161–1170.
crossref pmid

9. Valkovic P, Minar M, Singliarova H, et al. Pain in Parkinson’s disease: A cross-sectional study of its prevalence, types, and relationship to depression and quality of life. PLoS One. 2015; 10:8.

10. Jankovic J, McDermott M, Carter J, et al. Variable expression of Parkinson’s disease: A base-line analysis of the DAT ATOP cohort. Neurology. 1990; 40:10. 1529–1529.

11. Pont-Sunyer C, Hotter A, Gaig C, et al. The onset of nonmotor symptoms in parkinson’s disease (the onset pd study). Mov Disord. 2015; 30:2. 229–237.
crossref pmid

12. Chaudhuri KR, Rizos A, Trenkwalder C, et al. King’s Parkinson’s disease pain scale, the first scale for pain in PD: An international validation. Mov Disord. 2015; 30:12. 1623–1631.
crossref pmid

13. Ministry of Employment and Labor. 2012 Korean Longitudinal Study of Ageing(KLoSA). Korea Employment Information Service;2013.

14. Duvoisin RC, Marsden CD. Note on the scoliosis of Parkinsonism. J Neurol Neurosurg Psychiatry. 1975; 38:8. 787–793.
crossref pmid pmc

15. Djaldetti R, Shifrin A, Rogowski Z, Sprecher E, Melamed E, Yarnitsky D. Quantitative measurement of pain sensation in patients with Parkinson disease. Neurology. 2004; 62:12. 2171–2175.
crossref pmid

16. Gerdelat-Mas A, Simonetta-Moreau M, Thalamas C, et al. Levodopa raises objective pain threshold in Parkinson’s disease: A RIII reflex study. J Neurol Neurosurg Psychiatry. 2007; 78:10. 1140–1142.
crossref pmid pmc

17. Gandolfi M, Geroin C, Antonini A, Smania N, Tinazzi M. Understanding and Treating Pain Syndromes in Parkinson’s Disease. International Review of Neurobiology. 134:Academic Press Inc;2017. p. 827–858.
crossref pmid

18. Jarcho JM, Mayer EA, Jiang ZK, Feier NA, London ED. Pain, affective symptoms, and cognitive deficits in patients with cerebral dopamine dysfunction. Pain. 2012; 153:4. 744–754.
crossref pmid

19. Hanagasi HA, Akat S, Gurvit H, Yazici J, Emre M. Pain is common in Parkinson’s disease. Clin Neurol Neurosurg. 2011; 113:1. 11–13.
crossref pmid

20. Tinazzi M, Del Vesco C, Fincati E, et al. Pain and motor complications in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006; 77:7. 822–825.
crossref pmid pmc

21. Müller T, Muhlack S, Woitalla D. Pain perception, pain drug therapy and health status in patients with Parkinson’s disease. Neuroepidemiology. 2011; 37:3–4. 183–187.
crossref pmid

22. Scott B, Borgman A, Engler H, Johnels B, Aquilonius SM. Gender differences in Parkinson’s disease symptom profile. Acta Neurol Scand. 2000; 102:1. 37–43.
crossref pmid

23. Han CS, Pae CU. Pain and Depression: A Neurobiological Perspective of Their Relationship. Psychiatry Investig. 2015; 12:1. 1–8.
crossref pmid pmc

24. Beiske AG, Loge JH, Rønningen A, Svensson E. Pain in Parkinson’s disease: Prevalence and characteristics. Pain. 2009; 141:1–2. 173–177.
crossref pmid

25. Jankovic J, McDermott M, Carter J, et al. Variable expression of Parkinson’s disease: A base-line analysis of the DAT ATOP cohort. Neurology. 1990; 40:10. 1529–1529.
crossref pmid

26. Jankovic J, Kapadia AS. Functional decline in Parkinson disease. Arch Neurol. 2001; 58:10. 1611–1615.
crossref pmid

27. Stebbins GT, Goetz CG, Burn DJ, Jankovic J, Khoo TK, Tilley BC. How to identify tremor dominant and postural instability/gait difficulty groups with the movement disorder society unified Parkinson’s disease rating scale: comparison with the unified Parkinson’s disease rating scale. Mov Disord. 2013; 28:5. 668–670.
crossref pmid

28. Eisinger RS, Hess CW, Martinez-Ramirez D, et al. Motor subtype changes in early Parkinson’s disease. Park Relat Disord. 2017; 43:67–72.

29. Kotagal V. Is PIGD a legitimate motor subtype in Parkinson disease? Ann Clin Transl Neurol. 2016; 3:6. 473–477.
crossref pmid pmc

30. Zella MAS, May C, Müller T, et al. Landscape of pain in Parkinson’s disease: impact of gender differences. Neurol Res. 2019; 41:1. 87–97.
crossref pmid

Editorial office contact information
3F, #26-27 Gayang-dong, Gangseo-gu Seoul, 157-200 Seoul, Korea
The Society of Korean Medicine
Tel : +82-2-2658-3627   Fax : +82-2-2658-3631   E-mail : skom1953.journal@gmail.com
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
Developed in M2PI