Such a Pain in the…Back?
Do you have aches and pains? You are not alone. Muscle and joint pains are common as we age. Pain is a normal, protective sensation to help you prevent further serious injury to your body. For example, the pain one might get from burning their hand on a stove tells them to: 1) pull their hand off the stove and 2) avoid doing that again in the future. Normally, pain from a specific injury subsides over time and eventually goes away completely. However, there are cases in which pain persists following, or even in the absence of, injury or damage to a body tissue. This long-lasting pain, commonly referred to as chronic pain, is considered abnormal.
Despite chronic pain being abnormal, it is very common among middle-aged and older adults throughout the world. Chronic pain affects more than one billion people worldwide. Interestingly, people with PD are very likely to experience pain. This is not just related to age because people with PD report pain more frequently than their age-matched peers who do not have PD. Pain may start before, around the time of, or after the diagnosis of PD. In one study, people with early PD rated pain as one of their three most bothersome symptoms.
There are many types of pain in PD. The most common type of pain is musculoskeletal pain, which is pain in or around the muscles and joints. People typically associate this pain with arthritis. The low back is the most common site of pain in people with PD, though pain is also common in the neck, shoulders, and knees. Estimates vary, but up to 74% of people with PD report having low back pain. This is important because low back pain is one of the leading causes of disability worldwide. Despite the fact that low back pain is highly prevalent among people with PD, it is often under-recognized and under-treated by healthcare professionals.
Regular movement and exercise is a critical piece of self-management of PD. If you have low back pain or any other type of pain and it impacts your ability to move, exercise, or perform daily activities, you should discuss this with your physician. They may recommend over-the-counter or prescription pain medication. Further, they may refer you to a physiotherapist. Physiotherapists are trained to evaluate and treat people with pain. It is important that you work with your physician to find a physiotherapist who frequently evaluates people with PD. This is because there are unique aspects of PD that must be considered when developing treatment plans to reduce pain. As a physiotherapist and clinician-scientist at Washington University in St. Louis, I am particularly interested in better understanding low back pain in people with PD.
Our preliminary work in people with PD indicates low back pain affects the ability to stand for extended periods of time, walk long distances, and lift heavy objects. Further, our findings suggest low back pain may impact sleep in people with PD. Greater low back pain severity was associated with reduced quality of life and physical activity level. This work convinced us to continue studying low back pain in people with PD with the ultimate goal of finding effective treatments for reducing low back pain. To reach this ultimate goal, we must first identify potential treatment targets.
To do this, we are studying which factors might be most closely linked to low back pain in PD. The factors fall into three general categories: 1) movement, 2) sensory, and 3) psychologic. Movement-related factors like posture, muscle flexibility, and strength may be related to back pain in PD. Regarding sensory factors, PD itself, particularly the loss of dopamine, may make people with PD more sensitive to pain. We are working to understand if people with PD who have low back pain perceive pain differently compared to those with PD who do not have low back pain. Finally, psychologic factors like depression or anxiety, also common in PD, may worsen low back pain. This work will help us understand how to design future treatments. For example, if we find that muscle stiffness is strongly related to low back pain, we might design a study focused on stretching stiff muscles to determine its effect on pain.
In summary, much work needs to be done better understand low back pain in PD. If you have low back pain, there are several important things to document. First, write down when your symptoms are best and worst. Are there certain movements that make it better or worse? Does it prevent you from starting or continuing an exercise program? Does exercise help to reduce the pain? Also, note whether your back pain changes if your anti-PD medication is working effectively compared to when it is not. These things are important to discuss with your physician, who can help you identify the best path for managing low back pain.
Resource: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821152/
Ryan Duncan, PT, DPT, MSCI is an Associate Professor of Physical Therapy & Neurology at the Washington University in St. Louis – School of Medicine, Program in Physical Therapy. He attended/presented past WPC Congresses.
Ideas and opinions expressed in this post reflect that of the author solely. They do not reflect the opinions or positions of the World Parkinson Coalition®