Another Parkinson’s pain that receives less attention than it should.                                        Some years ago I remember seeing posters in the London Underground that
showed an X-ray photo of an office worker sat at his desk with a kink in his lower back surrounded by a flash representing pain. The caption on the poster said “Back pain does not kill, IT TORTURES!” A very apt statement indeed as I and many, possibly the majority of Parkie people, experience this pain caused by our faulty posture. This Plain English article is based on a study that was recently published in the European Spine Journal.

The article focused on the prevalence of chronic lower back pain and lumbar deformities in patients with Parkinson’s disease. Back pain seems to be a relatively common symptom in Parkinson’s disease and patients are often afflicted by pain possibly due to a combination of faulty posture, abnormal muscle tone and truncal dystonia (Uncontrollable muscle contractions in the torso).

German researchers conducted an observational study to analyze the connection between lower back pain and Parkinson’s by studying its prevalence, its underlying skeletal changes in the spine and the relationship between spinal deformity and Parkinson’s specific symptoms. A total of 97 Parkinson’s patients and 97 individuals used as controls (free of the disorder or any other neuromuscular disease) filled in a questionnaire rating the intensity of local lumbar back pain. The intensity of leg radicular pain was measured by the VAS (Visual Analogue Scale) – a continuous scale used to measure pain intensity.

The participants permanent functional disability was assessed via the ODI (Oswestry Low Back Pain Disability Questionnaire). This was filled in by the participants themselves and covered ten different topics; Intensity of pain, lifting, ability to take care of oneself, ability to walk, ability to talk, sexual function, ability to stand, social life, sleep quality and ability to travel. Patients were asked to describe painful sensations they experienced, such as tingling, burning, pricking, numbness and paraesthesia (which is often described as a feeling of pins and needles).

Also assessed were Parkinson’s duration, medication in use, severity of motor symptoms (assessed by the Unified Parkinson’s Disease Rating Scale Part III or UPDRS III and the Hoehn and Yahr, which is a system used to track symptom progression. As a comparison, low back pain was more frequent and lasted longer in Parkinson’s patients than in controls (88% Vs. 65%, 16 years Vs. 11.8 years). I don’t think that would have come as a surprise to those of us with PD and back pain! Also, in patients with lower back pain, the pain was more frequent in the lower regions than in controls who also had lower back pain but not Parkinson’s. Lumbar pain intensity was also higher in Parkinson’s patients.
Interestingly, when comparing the sensations felt as pain, tingling, burning, etc… as mentioned above, there was no difference between Parkinson’s patients and the controls. Functional disability was also very similar between the two groups. According to the ODI results, minimal disability was reported by 44% of Parkinson’s patients, moderate disability by 28%, severe disability by 22% and “crippled” by 6%. Higher ODI scores correlated with higher Hoehn and Yahr stages and UPDRS III. Patients with hypokinetic Parkinson’s (Slow or reduced movement) experience higher degrees of lumbar and radicular pain than patients that experience tremors. 54 patients had an X-ray of the lumbar spine, of these 80% showed arthritic changes, 39% Scoliosis (curvature of the spine) and 24% had Spondylolisthesis, which refers to the slippage or displacement of a vertebra (commonly known as ‘slipped disc’).

Of 85 Parkinson’s patients with lower back pain, 20 were being treated by an orthopaedic specialist but only 9 had lumbar spine surgery, the lower number of patients undergoing surgery reflects the difficult surgical management of Parkinson’s patients with spinal deformities according to the researchers.

Of the 63 controls with low back pain only 24 received orthopaedic treatment. This greater percentage (24% Vs. 38%) of treated controls compared with Parkinson’s patients supports the notion that low back pain is an under-estimated issue in the disease. Low back pain and lumbar degeneration are common in Parkinson’s patients, both being related to movement disorder symptoms.

Unfortunately it looks like we will have to put up with a considerable degree of back pain for much of the time as all the above research identifies the root causes of lumbar pain but also shows it is a very persistent pain to deal with.
Lionel