This protocol applies to Parkinson's disease where the presenting pain is neuropathic in character — a mechanistically distinct situation from nociceptive pain, which follows a separate clinical pathway.
The patient has Parkinson's disease with neuropathic pain. Nociceptive pain has been identified as not the primary mechanism. This distinction is clinically important: the type of pain determines which treatment approach is appropriate.
When neuropathic pain in Parkinson's disease is severe, an opioid-based strategy may be considered as part of the management approach. The structured protocol specifies the clinical criteria, the relevant options, and the conditions under which they apply.
Full regimen, decision criteria, and sequencing are detailed in the protocol below.Neuropathic pain should be treated with anticonvulsants and/or antidepressants following the guideline for neuropathic pain treatment, with a preference for Gabapentin and/or Duloxetine (especially in comorbidity with depression).
In cases of severe pain, treatment with extended-release Oxycodone/Naloxone may be considered.
DOI: 10.1186/s42466-024-00325-4
View source ↗