Table I.

Five categories of pain associated with Parkinson’s disease.

Category	Clinical presentation	Treatment
(i) Musculoskeletal pain	Confined to the joints and corresponding muscles and leads to muscle tenderness, limited joint mobility and skeletal deformity. Typical onset is with motion or after rest. Worsened by parkinsonian rigidity, stiffness and immobility. Described as dull, cramping or aching.	Physical therapy. Passive/active motion exercises. Anti-inflammatory / analgesia medication. Orthopedic joint surgery followed by rehabilitation.
(ii) Radicular/neuropathic pain	Localized to specific neuronal distributions or dermatomes. Associated with motor or sensory signs of nerve/root entrapment. Described as tingling.	Physical therapy and use of proper posture. Decompressive surgery.
(iii) Dystonic pain	Attributed to visible dystonia involving any of the extremities. Facial and pharyngeal musculature may be involved. Onset follows sustained twisting movements and postures leading to forceful and painful muscle contractions. Dystonia may fluctuate with varying medication dosages.	Anticholinergics, amantadine, baclofen, apomorphine, and/or injections of botulinum toxin. Subthalamic nucleus or globus pallidus interna stimulation.
(iv) Akathisia	Described as a subjective feeling of restlessness.	Levadopa, dopamine agonists, opiates.
(v) Central/primary pain	Poorly localized pain not associated with a specific neuronal distribution or muscle groups/joints. Described as a subjective feeling of burning/tingling pain.	Neuropathic pain agents including: carbamazepine, gabapentin, tricyclic antidepressants, and opiates. Levodopa and dopaminergic agents may alleviate some symptoms as well.