O Rommel1, D Wejwer2, K Schybek2, T Przybilski3, G Jäger3, S Gräber4, D Berg4. 1. Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland. o.rommel@rommel-klinik.de. 2. Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland. 3. Abteilung für Orthopädie, Rommel-Klinik GmbH, 75323, Bad Wildbad, Deutschland. 4. Abteilung für Neurodegenerative Erkrankungen, Hertie-Institut für Hirnforschung, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.
Abstract
BACKGROUND: Lumbar back pain is a frequent symptom in patients with advanced Parkinson's disease. We examined the effect of modification of the dopaminergic medication, x-ray-controlled lumbar spine injections and analgesics combined with physiotherapy. METHODS: The data from 50 patients with Parkinson's disease and lumbar back pain were retrospectively analyzed. A structured L-dopa test was performed with all patients, whereby the pain intensity and mobility were monitored before and after the administration of L-dopa. Dopaminergic medication was adjusted in patients who reported either a reduction in pain intensity (> 20%) and/or an improvement of measured mobility and X-ray controlled lumbar spine injections were conducted in patients who reported persistent pain. Analgesics were introduced or dosages were raised in patients who had already received lumbar spine injections and continued to report pain. All patients participated in a daily physiotherapy program. RESULTS: In the L-dopa test an improvement of mobility could be demonstrated in 40 patients and reduced pain intensity in 21 patients. In 37 patients with a positive L-dopa test the dopaminergic medication was adjusted. In 12 of these patients (24%) a decrease of pain intensity could be observed. Due to persisting back pain in 30 patients lumbar spine injections were conducted. Of these patients 17 (34%) had pain improvement. In 20 patients analgesics were applied and induced pain relief in 15 patients (30%). Overall 44 patients (88%) had an improvement in pain. DISCUSSION: Even in cases of severe lumbar spine pathology adjustment of dopaminergic medication should be tested in all patients with Parkinson's disease and lumbar back pain. In patients with persistent pain facet joint injections as well as analgesics may be helpful and should be tested according to the predominant pain characteristics.
BACKGROUND:Lumbar back pain is a frequent symptom in patients with advanced Parkinson's disease. We examined the effect of modification of the dopaminergic medication, x-ray-controlled lumbar spine injections and analgesics combined with physiotherapy. METHODS: The data from 50 patients with Parkinson's disease and lumbar back pain were retrospectively analyzed. A structured L-dopa test was performed with all patients, whereby the pain intensity and mobility were monitored before and after the administration of L-dopa. Dopaminergic medication was adjusted in patients who reported either a reduction in pain intensity (> 20%) and/or an improvement of measured mobility and X-ray controlled lumbar spine injections were conducted in patients who reported persistent pain. Analgesics were introduced or dosages were raised in patients who had already received lumbar spine injections and continued to report pain. All patients participated in a daily physiotherapy program. RESULTS: In the L-dopa test an improvement of mobility could be demonstrated in 40 patients and reduced pain intensity in 21 patients. In 37 patients with a positive L-dopa test the dopaminergic medication was adjusted. In 12 of these patients (24%) a decrease of pain intensity could be observed. Due to persisting back pain in 30 patients lumbar spine injections were conducted. Of these patients 17 (34%) had pain improvement. In 20 patients analgesics were applied and induced pain relief in 15 patients (30%). Overall 44 patients (88%) had an improvement in pain. DISCUSSION: Even in cases of severe lumbar spine pathology adjustment of dopaminergic medication should be tested in all patients with Parkinson's disease and lumbar back pain. In patients with persistent pain facet joint injections as well as analgesics may be helpful and should be tested according to the predominant pain characteristics.
Entities:
Keywords:
Analgesics; Facet joint; L-dopa; Lumbar back pain; Spinal injections
Authors: Giovanni Defazio; Alfredo Berardelli; Giovanni Fabbrini; Davide Martino; Emiliana Fincati; Antonio Fiaschi; Giuseppe Moretto; Giovanni Abbruzzese; Roberta Marchese; Ubaldo Bonuccelli; Paolo Del Dotto; Paolo Barone; Elisa De Vivo; Alberto Albanese; Angelo Antonini; Margherita Canesi; Leonardo Lopiano; Maurizio Zibetti; Giuseppe Nappi; Emilia Martignoni; Paolo Lamberti; Michele Tinazzi Journal: Arch Neurol Date: 2008-09
Authors: Stefan Lakemeier; Marcel Lind; Wolfgang Schultz; Susanne Fuchs-Winkelmann; Nina Timmesfeld; Christian Foelsch; Christian D Peterlein Journal: Anesth Analg Date: 2013-04-30 Impact factor: 5.108