Key Facts

  • Most people experience some form of pain at some point in the course of the illness.
  • Pain in joints and muscles are more common due to motor symptoms< associated with PD.

Clinical Best Practices

  • No evidence-based guidelines available.

Pain in PD can occur for a variety of reasons. Pain occurs in up to 75% of PD patients; it is typically individualized and does not always correlate to stage.

Common Causes

  • Exacerbation of musculoskeletal pain due to immobility/rigidity
  • Dystonia
  • Sensory symptoms (neuropathic pain)


  • Comprehensive medical history and physical examination
  • “Off” dystonia pain—occurs in the “off” state
  • “Off” sensory symptoms—also in the “off” state
  • Musculoskeletal pain that does not vary with levodopa< dosing, improves with movement

Barriers to Diagnosis

  • Patients often do not disclose pain.

Treatment Options

  • Adjust levodopa or other antiparkinsonian medication doses.
  • Encourage exercise< and maximum exertion exercises.
  • Use physiotherapy.
  • Recommend conventional narcotics, aspirin, ibuprofen, and other medications that may be helpful.
  • Inject botulinum toxin for dystonia in “off” state.

Important Caveats to Therapy


Tinazzi M, Recchia S, Simonetto S, et al. Muscular pain in Parkinson's disease and nociceptive processing assessed with CO2 laser-evoked potentials. Mov Disord. 2010;25(2):213-220.