Investigating Pain Catastrophizing To Improve Treatment Of Pain And Psychological Distress in Parkinson’s Disease
In Parkinson’s disease, a large number of patients are confronted with pain. Clinical features of pain are quite heterogeneous among people with Parkinson’s disease (PwP), with several types of pain possibly co-occurring within the same person, sometimes reported before or at the onset of the disease.
The classification of pain in Parkinson’s continues to be a challenge. Thus, the complexity of the pain phenomenon in this disease makes it difficult to evaluate and treat.
Additionally, pain in Parkinson’s is commonly associated with symptoms of anxiety and depression. However, the processes involved in the relationship between pain and psychological distress are not well understood.
Our study aimed to address two main questions:
1. What are the specifics of pain experienced by individuals with PD?
2. Is a specific pain coping style involved in the relationship between anxiety-depressive symptoms and pain?
To this end, we invited French-speaking PwP to complete an online, self-administrated survey from April to July 2021.
After providing socio-demographic and medical data, participants completed three different questionnaires evaluating several aspects of pain:
- characterization of Parkinson’s related pain using the King’s Questionnaire for Pain Assessment in Parkinson’s Disease
- sensory and emotional repercussions of the pain using the MPQ-QDSA
- and localization, severity and interference of pain using the Brief Pain Inventory.
Participants were also evaluated for psychological distress (severity of depressive and anxiety symptoms), as well as their use of pain coping strategies (cognitive and behavioral strategies adopted by individuals to cope with pain: (1) distraction, (2) catastrophizing, (3) ignoring pain sensations, (4) reinterpreting pain sensations, and (5) praying).
350 PwP connected to the survey. In total, 169 respondents completed the survey to its end.
The mean participants’ age was 64.4 years and 55% were female. A majority of them (56%) were living in France, 37% in Canada (Quebec), and 7% in other French speaking countries.
Depending on the tool used, 82.8% to 95.2% of participants reported pain. The most prevalent parkinsonian pains were musculoskeletal (79.9%), fluctuation-related pain (68.7%) and nocturnal pain (62.4%).
Levels of psychological distress were higher than those in the general population, with
- 23.5 % and 67.5% of participants showing respectively significant levels of depressive and anxiety symptoms.
Moreover, our statistical results indicate that, among the pain coping strategies used by the participants, only pain catastrophizing is a mediator in the relationship between psychological distress and pain. This means that when PwP display elevated levels of distress, and when they tend to catastrophize, their experience of pain is worsened.
CLINICAL AND RESEARCH PERSPECTIVES
Our findings bring new material to the comprehension of pain and psychological distress in Parkinson’s, assessed with an online international cross-sectional survey:
1. Our results reinforce the recommendations that a specific Parkinson’s pain questionnaire should be used to help patients better identify their pain before medical investigations. As PwP often have difficulties discriminating parkinsonian from non-parkinsonian pain, this questionnaire may help them to reflect on their specific sensations before the medical visits, facilitating their description of pain during the visits and limiting under-reported pain. The medical diagnosis and the ensuing treatments would be better targeted and easier to evaluate.
2. We found that the evaluation of pain quality (sensory and emotional repercussions of the pain), as a complement to the evaluation of pain intensity, is also crucial in the understanding of PwPs’ pain perception. This finding highlights the fact that evaluating how PwP feel about their unpleasant sensations, especially when they are undergoing psychological distress, is as pertinent, if not more so, as asking them to objectively rate their pain intensity.
3. Our results indicated that when PwP display elevated levels of distress, and when they tend to catastrophize, their experience of pain is worsened. This is a major result, as pain catastrophizing had never been investigated in its relationship between psychological distress and pain in Parkinson’s. This finding opens novel perspective: unlike pain and psychological distress in Parkinson’s, pain catastrophizing is easy to assess. Moreover, whereas non-motor symptoms can be resistant to treatment, catastrophizing, as a cognitive response, should be accessible to specific interventions aimed at enhancing cognitive flexibility and facilitating adaptation to symptoms. When focused on improving cognitive flexibility and reducing automatic cognitive processes, interventions such as CBT (Cognitive Behavioral Therapy), meditation programs like MBCT (Mindfulness Based Cognitive Therapy) or ACT (Acceptance Commitment Therapy) have shown their efficacy in treating chronic pain disease and should be more extensively developed in Parkinson’s.
4. Moreover, in terms of research perspectives, future studies might focus on establishing pain trajectories in Parkinson’s and their association with psychological distress and pain coping strategies.
Sylvia Zimmers, PhD is a clinical psychologist at the Laboratory of Psychopathology and Health Processes, Université Paris Cité, F-92100 Boulogne-Billancourt, France. She was a poster presenter at the WPC 2023.
Ideas and opinions expressed in this post reflect that of the author solely. They do not reflect the opinions or positions of the World Parkinson Coalition®