ABSTRACT
BACKGROUND: Lumbar back pain is a frequent symptom in patients with advanced Parkinson's disease. We examined the effect of modification of the dopaminergic medication, x-ray-controlled lumbar spine injections and analgesics combined with physiotherapy. METHODS: The data from 50 patients with Parkinson's disease and lumbar back pain were retrospectively analyzed. A structured L-dopa test was performed with all patients, whereby the pain intensity and mobility were monitored before and after the administration of L-dopa. Dopaminergic medication was adjusted in patients who reported either a reduction in pain intensity (> 20%) and/or an improvement of measured mobility and X-ray controlled lumbar spine injections were conducted in patients who reported persistent pain. Analgesics were introduced or dosages were raised in patients who had already received lumbar spine injections and continued to report pain. All patients participated in a daily physiotherapy program. RESULTS: In the L-dopa test an improvement of mobility could be demonstrated in 40 patients and reduced pain intensity in 21 patients. In 37 patients with a positive L-dopa test the dopaminergic medication was adjusted. In 12 of these patients (24%) a decrease of pain intensity could be observed. Due to persisting back pain in 30 patients lumbar spine injections were conducted. Of these patients 17 (34%) had pain improvement. In 20 patients analgesics were applied and induced pain relief in 15 patients (30%). Overall 44 patients (88%) had an improvement in pain. DISCUSSION: Even in cases of severe lumbar spine pathology adjustment of dopaminergic medication should be tested in all patients with Parkinson's disease and lumbar back pain. In patients with persistent pain facet joint injections as well as analgesics may be helpful and should be tested according to the predominant pain characteristics.
