The Parkinson disease pain classification system: results from an international mechanism-based classification approach

Veit Mylius, Santiago Perez Lloret, Rubens G. Cury, Manoel J. Teixeira, Victor R. Barbosa, Egberto R. Barbosa, Larissa I. Moreira, Clarice Listik, Ana M. Fernandes, Diogo de Lacerda Veiga, Julio Barbour, Nathalie Hollenstein, Matthias Oechsner, Julia Walch, Florian Brugger, Stefan Hägele-Link, Serafin Beer, Alexandra Rizos, Kallol Ray Chaudhuri, Didier BouhassiraJean Pascal Lefaucheur, Lars Timmermann, Roman Gonzenbach, Georg Kägi, Jens Carsten Möller, Daniel Ciampi de Andrade

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)


ABSTRACT: Pain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 ± 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.

Original languageEnglish
Pages (from-to)1201-1210
Number of pages10
Issue number4
Publication statusPublished - 1 Apr 2021


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