PD and Chronic Pain
 

My Dad has suffered from Parkinson’s for around 15 years. He does not suffer tremors but his main issue is chronic pain linked to both Parkinson’s and problems following a Girdlestone operation (removal of hip joint) around 5 years ago. The pain is not linked to infection.

He can only lie on his left side or back, due to the painful condition of his right hip area. He cannot put any weight on his right leg without severe pain, and can only walk with either crutches or a walking frame.

He suffers 24/7 chronic pain focused on his right hip, right knee, and the intervening muscles, Similar pain radiates up his right side and into the base of his neck. and across his lower back.

Separate pain, which he ascribes to Parkinson’s, focuses on his right shoulder, and down to and beyond his elbow joint. This arrived in the last 18 months or so, and seems irrespective of use, or rest or application of heat.

He is currently taking no pain medication whatsoever, neither analgesic nor NSAID, and has not done so for many months, due to inability to find an effective medicine or one which did not cause fluid retention.

He has tried Morphine but this was found to give early undesirable side effects and little relief. Tramadol was taken intermittently for perhaps 3 years and gave no relief. Fentanyl was administered via spinal infusion during distraction of femur & pelvis but gave no relief. Paracetamol
at below maximum dose gave no relief but resulted in fluid retention.

Pregabalin and Gabapentin have also resulted in fluid retention. As have the following NSAID’s: Diclofenac, Ibuprofen, Naproxen, Piroxicam and Rofecoxib

Have we run out of options or is there anything out there which anyone can suggest as the situation is desperate and we would appreciate any help anyone can provide.

Many thanks

Ettie

have you gone to a pain management clinic??
it sounds to me like their is significant nerve impingement(s). The upper body and hip pain are probably caused by different conditions.
I would suggest a good pain management clinic to assess his condition.

Charlie

I'm very sorry to hear of your dad's pain. I've just been researching the Girdlestone procedure because one of the patients in our hospital just had it done. On average, in different studies, about 74% of patients are either completely or almost painfree after. What I wanted to pass on is that some of them go on to have a total hip replacement done after they're healed, on average 13 months after the Girdlestone. This is considered the best option for a painfree functional outcome. Has that been considered for your dad? If you're into research, you can use pubmed at the top of this page. Put in Girdlestone, or excision arthroplasty hip, or resection arthroplasty hip, and you'll come up with quite a few article titles. You could pick and choose what seemed to fit your dad's situation best. Good luck to him.

Hello, please ask the doctor about etodolac (it's generic), an NSAID that preferentially combats COX-2. I find it extremely effective without side effects. Other NSAIDs like ones you mentioned were not effective at all and gave me stomach pains.

I found it doing research after my Vioxx was taken off the market. For some reason, most doctors aren't aware of etodolac.

I take it with misoprostol to protect my stomach, because etodolac does reduce COX-1, too. I also take Protonix for my stomach and acid reflux.

Good luck.

Role of central dopamine in pain and analgesia.
 

Expert Rev Neurother. 2008 May;8(5):781-97.
Role of central dopamine in pain and analgesia.

Wood PB.

Angler Biomedical Technologies, LLC, 18401 Reed Parks Road, Jonestown, TX 78645, USA. pwood@anglerbiomedical.com

Recent insights have demonstrated a central role for dopaminergic neurotransmission in modulating pain perception and natural analgesia within supraspinal regions, including the basal ganglia, insula, anterior cingulate cortex, thalamus and periaqueductal gray. In addition, while the participation of serotonin and norepinephrine in spinal descending inhibition of pain is well known, a critical role for dopamine in descending inhibition has also been demonstrated. Decreased levels of dopamine likely contribute to the painful symptoms that frequently occur in Parkinson's disease. Moreover, abnormalities in dopaminergic neurotransmission have been objectively demonstrated in painful clinical conditions, including burning mouth syndrome, fibromyalgia and restless legs syndrome. Evidence from animal models and indirect evidence from pharmaceutical trials also suggest a role for dopamine in chronic regional pain syndrome and painful diabetic neuropathy. Several novel classes of medication with analgesic properties have bearing on dopaminergic activity as evident in the capacity of dopamine antagonists to attenuate their analgesic capacity. An expanded appreciation for the role of dopamine in natural analgesia provides the impetus for further study involving preclinical models and advanced neuroimaging techniques in humans, which may lead to the development of novel therapeutic strategies.

PMID: 18457535 [PubMed - in process]

http://tinyurl.com/5d3apg

http://www.docguide.com/news/content...=18457535&ref=

Hi Charlie

Thanks for your message.

Dad is now seeing a pain specialist so fingers crossed they may be able to come up with some new ideas which he has not explored before.

Ettie

]

Hi Wendy

Thanks vey much for your reply.

They have considered getting another hip put in but have not done so as yet. The girdlestone op was done around 4 years ago now and Dad has deteriorated substantially since then. His deterioration caused by both Parkinson's and Chronic Pain affecting his mobility so it is unlikely he will go for further surgery now.

Thanks for the tip of using Pubmed, I will have a look at it today and search around to see what I can find.

Thanks again.

Ettie

Hi ZucchiniFlower

Thanks very much for your message and for the suggestion of Etodolac.

I am going to look this up right away and will pass this information onto my Dad

Thanks once again and all the very best to you.

Kind regards

Ettie

Hi Olson

Thanks very much for your message.

I shall be reading this fully and passing it onto my Dad and will also do further research on Pubmed so thanks once again for taking the time to post the message.

Regards

Ettie

I recommend:

Jon Kabat-Zinn
Full catastrophe living: how to cope with stress, pain and illness using mindfulness meditation.

Dopavite (to raise dopamine levels)

Rapeseed Oil (for the Omegas)

A good multivitamin

Some kind of exercise, even if it's only yoga sitting in a chair

The best food you can afford