More than 50% of patients with Parkinson disease (PD) can have chronic pain. PD pain has been associated with reduced quality of life scores on validated measures. The most common source of PD pain is musculoskeletal in origin. This pain may manifest as rigidity, cramps, shoulder discomfort, spinal or hand and foot deformities, dystonic pain, or nonradicular back pain. Our case illustrates improvement in chronic pain following bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in a 45-year-old patient with PD. Approximately 1 year after PD onset, he developed constant pain and tremor in his left upper extremity, which gradually worsened over time. Initially, carbidopa/levodopa completely alleviated both his arm tremor and pain. Over the next several years, he developed off periods that were associated with bothersome tremor and pain, and on periods that were associated with prominent neck and left arm dyskinesia, both of which were associated with significant pain. At age 60 years, after 15 years of PD, he underwent bilateral STN DBS implantation. Following DBS, he had significant improvement in his left arm tremor, rigidity, motor fluctuations, and pain. He also had a 70% reduction in his dopaminergic medication and complete resolution of dyskinesia and neck pain.
Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson Disease with Prior Pallidotomy or Thalamotomy
