Painful or unpleasant sensations in patients with PD are more common than one might expect, approximating 50% in most series.18-11 The true prevalence of pain in PD remains unknown but is suspected to be higher than in the general population because of the rigidity, dystonia, physical restraints, and motor complications that the disease imposes. In five recent surveys of painful sensations in patients with PD, summarized in Table 19.1, the prevalence of pain has been estimated at between 38 and 54%.1,8-11
The challenge for the clinician is to recognize when a patient's complaint of pain requires further evaluation and to categorize the painful symptoms of PD into a framework for diagnosis and treatment. One recent study classified painful sensations by etiology.11 In this survey, 43 of 95 patients with PD experienced pain. Muscle cramps occurred in 32 (74%), dystonia-associated pain occurred in 12 (28%), radicular or neuritic pain occurred in 6 (14%), and joint pains occurred in 6 (14%). In other series, there is a higher incidence of central or primary parkinsonian pain10 or akathisia.1
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