Background: Patients suffering from Parkinson’s disease (PD) often complain about painful sensations. Recent studies detected increased subjective pain sensitivity and increased spinal nociception, which appeared reversible by dopaminergic treatment. Possibly, reduced descending pain inhibition contributes to this finding.
Objective: We investigated subjective pain thresholds as well as nociceptive reflex thresholds to isolate potential loci of the pathophysiological changes within the pain pathway. In addition, the diffuse noxious inhibitory control (DNIC) system as one form of descending control was assessed.
Method: Fifteen patients with PD and eighteen controls participated in the study. Electrical and heat pain thresholds as well as the nociceptive flexion reflex (NFR) thresholds were determined. Thereafter, the electrical pain thresholds were measured once during painful heat stimulation (conditioning stimulation) and twice during innocuous stimulation (control stimulation).
Results: The PD patients exhibited lower electrical and heat pain thresholds as well as lower NFR thresholds. The suppression of the electrical pain thresholds during painful heat stimulation (conditioning stimulation) compared to control stimulation did not differ significantly between the groups. No differences of the thresholds between PD patients with and without clinical pain were seen.
Conclusions: Finding the NFR threshold to be decreased in addition to the decreased electrical and heat pain thresholds indicates that the pathophysiological changes either already reside at or reach down to the spinal level. A reduced activation of the DNIC system was apparently not associated with increased pain sensitivity, suggesting that DNIC-like mechanisms do not significantly contribute to clinical pain in PD.