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Musculoskeletal pain arises after brain stimulation in Parkinson's disease

Subthalamic nucleus deep brain stimulation alleviated pain in patients with Parkinson’s disease, however, most patients developed new musculoskeletal pain despite the surgery, according to recently published data.

“The results of the present study highlight once again that musculoskeletal problems should be considered when predicting the operative outcome before surgery, and continuous evaluation and treatment of musculoskeletal pain should be performed after surgery,” Yu Hin Jung, MD, of the department of neurology, College of Medicine at Kyung Hee University, Seoul, South Korea, and colleagues wrote.

Researchers studied 24 patients with Parkinson’s disease who had undergone subthalamic nucleus deep brain stimulation (STN DBS) from June 2005 through March 2006 to assess the long-term effects it had on pain. Patient’s scored their pain from 0 to 10 (no pain to maximal pain) in seven areas: the head, neck, trunk, and upper and lower extremities on either side. Quality of pain, per body part, then was grouped into one of four categories: dystonic, musculoskeletal, radiculoneuritic and central.

Before surgery, 67% of patients experienced off-state pain, with each patient averaging pain in three areas. After an 8-year postsurgical follow-up, off-state pain was improved or gone in all 16 patients. At baseline, the number of body parts with pain was 21, which decreased to 11 at follow-up.

Mean off-state pain scores improved from 6.2 at baseline, to 3.5 at 8 years after surgery.

During follow-up, however, 18 patients developed new pain, including musculoskeletal (n = 11), central (n = 4), radiculoneuritic (n = 3) and dystonic pain (n = 1). Mean pain scores were 4.4, with 47 body parts having newly developed pain.

In an accompanying editorial, Pravin Khemani, MD, and Richard B. Dewey Jr., MD, of the department of neurology and neurotherapeutics at the University of Texas Southwestern Medical Center, said that while Jung and colleagues’ study had several limitations, it offered a new look at how STN DBS affects long-term pain.

“This underscores the importance of performing future trials with larger cohorts, longer observational periods, and standard methods to enable effective interpretation of outcomes. For now, we have learned that STN DBS does not take the ouch of Parkinson’s disease in the long run,” Khemani and Dewey wrote. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.