Image/artwork by Ros Webb
One of the biggest complaints I hear from people in PD support groups is a continuous relentless severe leg pain. Prior to a decade ago, I as all my fellow movement disorder specialist would have not thought leg pain to be a direct precursor of PD or an initial non-motor symptom. My grandmother often complained of pain and deep aches in her calves and in her legs which started before her tremors and shuffling were noticeable. But, I was unaware of the connection at the time and erroneously assumed her pain was neuropathic in nature due to her diabetes but was always somewhat surprised that she continue to complain of this pain on and off throughout her illness despite neuropathic medication. With hind sight what she was experiencing was central pain of PD. I too had severe pain first in one leg then the other which would come on suddenly without warning stopping me in my tracks throughout the day. I was constantly asking my husband to massage my legs just as my grandmother had asked of us time and time again.
So why do we have leg pain in PD and what can we do to relieve the discomfort?
First, some believe that lower limb pain is a specific non-motor phenotype variant of central pain in Parkinson’s disease. I, too, believe this; more importantly it can be one of the very first signs of PD as it was for me. This pain is usually bilateral.
Second, leg pain can also occur secondary to dystonia as an initial symptom or as a consequence of long term levodopa use (most common). When related to levodopa it usually occurs as a wearing off but can also occur at peak dose. In most cases this leg pain is unilateral and has direct correlation to medication intake. When is due to dystonia pain is more common in early morning. This type of leg pain is usually accompanied by toes curling and foot abnormally posturing.
Third, musculoskeletal pain due to rigidity, abnormal posturing and lack of mobility affects legs commonly causing pain in the legs, however this pain is usually more pronounced on the more affected side.
Treatments therefore depend on properly identifying the source of pain.
• If bilateral always assume it is central pain- pain due to PD and treat accordingly. As I mentioned many times before, Azilect works great for this type of pain.
• Massage therapy works for all types of leg pain-my favorite.
• If having pain due to dystonia first find out if occurring at end of dose or at peak dose so medications can be adjusted. If medication adjustment don’t work consider DBS. Pain due to dystonia also responds well to Botox injections, centrally acting muscle relaxants alone or in combination with other treatment modalities. Physical therapy (PT) can go a long way to alleviating pain of this type.
• To avoid and alleviate pain caused by stiff muscles the best treatment is activity in the form of stretching exercises- any number of activities will do such as tai-chi, yoga.
• Lastly, don’t forget to stay well hydrated.
After traveling from coast to coast last few weeks, I too have experienced once again severe leg pain, something I have not had in a year at least. So, now that I am back home I can get a nice massage (thanks to friend’s thoughtfulness), rest, put my legs up, restart my exercise routine and increase my hydration.
Happy Fourth of July everyone!!!
P.s thank you for nominating me for Best in show Blog #WEGOHEALTHAWARDS – it is a true honor to represent the Pd community. if interested you can check out my profile there and vote for me or nominate someone else. Thank you for opportunity of letting me serve you and represent you.
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