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Facilitated temporal summation of pain at spinal level in Parkinson's disease

Authors

  • Armando Perrotta MD, PhD,

    Corresponding author
    1. Department of Neurology, IRCCS “C. Mondino Institute of Neurology” Foundation, University of Pavia, Pavia, Italy
    2. IRCCS “Neuromed”, University of Rome “Sapienza”, Pozzilli, Isernia, Italy
    • Department of Neurology, IRCCS “C. Mondino Institute of Neurology” Foundation, Via Mondino 2, 27100 Pavia, Italy

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  • Giorgio Sandrini MD,

    1. Department of Neurology, IRCCS “C. Mondino Institute of Neurology” Foundation, University of Pavia, Pavia, Italy
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  • Mariano Serrao MD, PhD,

    1. Neurorehabilitation Unit, University of Rome “Sapienza” Polo Pontino-ICOT, Latina, Italy
    2. Casa di Cura Policlinico Italia, Rome, Italy
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  • Simona Buscone MD,

    1. Department of Neurology, IRCCS “C. Mondino Institute of Neurology” Foundation, University of Pavia, Pavia, Italy
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  • Cristina Tassorelli MD, PhD,

    1. Department of Neurology, IRCCS “C. Mondino Institute of Neurology” Foundation, University of Pavia, Pavia, Italy
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  • Michele Tinazzi MD, PhD,

    1. Dipartimento di Scienze Neurologiche e della Visione, Sezione di Neurologia Riabilitativa, Università di Verona, Italy
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  • Roberta Zangaglia MD, PhD,

    1. Parkinson Unit, IRCCS “C. Mondino Institute of Neurology” Foundation, University of Pavia, Pavia, Italy
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  • Claudio Pacchetti MD,

    1. Parkinson Unit, IRCCS “C. Mondino Institute of Neurology” Foundation, University of Pavia, Pavia, Italy
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  • Michelangelo Bartolo MD, PhD,

    1. Department of Neurology, IRCCS “C. Mondino Institute of Neurology” Foundation, University of Pavia, Pavia, Italy
    2. IRCCS “Neuromed”, University of Rome “Sapienza”, Pozzilli, Isernia, Italy
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  • Francesco Pierelli MD,

    1. IRCCS “Neuromed”, University of Rome “Sapienza”, Pozzilli, Isernia, Italy
    2. Neurorehabilitation Unit, University of Rome “Sapienza” Polo Pontino-ICOT, Latina, Italy
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  • Emilia Martignoni MD

    1. Department of Clinical Medicine, University of Insubria, Varese, Neurorehabilitation Unit and Movement Disorders Unit, IRCCS Fondazione S. Maugeri, Tradate, Italy
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  • Relevant conflict of interest: Nothing to report.

Abstract

Background:

Pain is one of the major nonmotor symptoms of Parkinson's disease. We hypothesized that Parkinson's disease patients could show an early diffuse abnormal processing of the nociceptive inputs also in the absence of clinical pain syndrome and that this could represent the physiopathological substrate to explain the high incidence of diffuse pain symptoms.

Materials and methods:

We used the temporal summation threshold of the nociceptive withdrawal reflex and the related pain sensation to evaluate the facilitation in pain processing at spinal level. Fifteen (7 Women; 8 Men; mean age 63.0 ± 9.1) Parkinson's disease patients without clinical pain and 12 (6 Women, 6 Men; mean age 61.2 ± 4.2) healthy subjects were recruited. Parkinson's disease group has been subdivided into two subgroups, 7 early-stage Parkinson's disease patients with unilateral signs (Hoehn and Yahr stage 1) and 8 patients in a more advanced stage of the disease showing bilateral parkinsonian signs (Hoehn and Yahr stages 2 and 2.5), both “on” and “off” treatments with levodopa.

Results:

A significant facilitation in temporal summation of pain (reduced temporal summation threshold and increased painful sensation) was found in Parkinson's disease patients when compared with controls. This facilitation is more evident in Parkinson's disease with bilateral signs and on the side more affected in Parkinson's disease with unilateral signs. Levodopa administration failed to significantly modify the neurophysiological abnormalities; however, a slight improvement has been detected.

Conclusions:

The increased gain in pain processing at spinal level in Parkinson's disease patients could be a consequence of the degenerative phenomena involving supraspinal projections implicated in the modulation of pain processing and could make Parkinson's disease patients more predisposed to develop a pain condition. © 2010 Movement Disorder Society

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