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. 2021 Apr 1;162(4):1201-1210.
doi: 10.1097/j.pain.0000000000002107.

The Parkinson disease pain classification system: results from an international mechanism-based classification approach

Veit Mylius  1   2   3 , Santiago Perez Lloret  4 , Rubens G Cury  5 , Manoel J Teixeira  5 , Victor R Barbosa  5 , Egberto R Barbosa  5 , Larissa I Moreira  5 , Clarice Listik  5 , Ana M Fernandes  5 , Diogo de Lacerda Veiga  5 , Julio Barbour  5 , Nathalie Hollenstein  1 , Matthias Oechsner  6 , Julia Walch  2 , Florian Brugger  2 , Stefan Hägele-Link  2 , Serafin Beer  1 , Alexandra Rizos  7 , Kallol Ray Chaudhuri  7   8   9 , Didier Bouhassira  10 , Jean-Pascal Lefaucheur  11 , Lars Timmermann  3 , Roman Gonzenbach  1 , Georg Kägi  2 , Jens Carsten Möller  3   6 , Daniel Ciampi de Andrade  5
Affiliations

The Parkinson disease pain classification system: results from an international mechanism-based classification approach

Veit Mylius et al. Pain. .

Abstract

Pain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 ± 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.

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Conflict of interest statement

V. Mylius received honoraria from LicherMT, Boston Scientific, and Abbvie. SPL received honoraria from IPMDS and consulted for Merz Pharmaceuticals. F. Brugger received research grants from Baasch-Medicus Foundation and Forschungskommission Kantonsspital St. Gallen, and a travel grant from Abbvie Switzerland. A. Rizos received salary support from the Institute for National Health Research (NIHR) Clinical Research Network (CRN) South London and honoraria from Britannia Pharmaceuticals Ltd. K.R. Chaudhuri received honoraria for advisory boards by AbbVie, UCB, Pfizer, Jazz Pharma, GKC, Bial, Cynapsus, Novartis, Lobsor, Stada, Medtronic, Zambon, Profile, Sunovion, Roche, Therevance, and Scion, honoraria for lectures by AbbVie, Britannia, UCB, Mundipharma, Zambon, Novartis, Boeringer Ingelheim, Neuroderm, and Sunovion, grants (investigator-initiated) by Britania Pharmaceuticals, AbbVie, UCB, GKC, and Bial, academic grants by EU (Horizon 2020), IMI, Parkinson UK, NIHR, PDNMG, Kirby Laing Foundation, NPF, and MRC. L. Timmermann received payments as a consultant for Boston Scientific, and honoraria as a speaker on symposia sponsored by UCB, Desitin, Boston Scientific, and Abbott. R. Gonzenbach received honoraria from Almirall, Bayer, Sandoz, Biogen, Roche, Novartis, and Sanofi. G. Kägi received honoraria from Bayer. D. Ciampi de Andrade consulted for Merk, Grunenthal, Cristalia, and Novartis, and investigator-initiated research grant from Grunenthal, Mundipharma, Pfizer, and Abbott. The remaining authors have no conflicts of interest to declare.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
The PD-Pain Classification System (PD-PCS) with a complementary QR code for a web-based online version.
Figure 2.
Figure 2.
Prevalence of nociceptive, neuropathic and nociplastic pains with respect to the defined pain syndrome at the first visit (in % of the total sample, n=159). PD, Parkinson disease.
See this image and copyright information in PMC

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