4.3.1 Pain
Pain is a key symptom of Parkinson’s. The priority is to regularly assess and monitor for pain or discomfort. It must not be assumed that all pain is Parkinson’s related as it may be due to other reasons, perhaps related to comorbidities.
Questioning the individual about their pain and listening carefully to their description will permit the professional to judge the type of pain and its appropriate management.
Non-verbal indices of pain such as groaning, agitation or tearfulness need to be considered if the individual has limited communication, and visual pain scales can also be useful in these situations.
Further reading
The following link provides examples of a number of pain scales: Pain assessment scales [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] (National Initiative on Pain Control, 2005).
Exercise for reflective practice
In your reflection log briefly discuss the type of guidance or care plans that are used in your area to direct and ensure good practice in identification and management of physical symptoms. Are they similar to the EEMMA acronym, or are they different but more appropriate to the clients you are caring for?
Non pharmacological and pharmacological management of pain
- Non pharmacological management: In advanced Parkinson’s this type of management is important to prevent exacerbation of hallucinations or decline in cognitive ability. It is also important when swallowing is compromised. This involves therapies such as limb massage, physiotherapy positional/postural changes, pressure relieving devices, transcutaneous electrical nerve stimulation (TENS) and acupuncture.
- Pharmacological interventions: A three-step analgesic ladder developed by the World Health Organization (WHO) for management of cancer-related pain is frequently used as a framework for prescribing analgesic pain relief. This three-step approach of administering the right drug at the right time is inexpensive and 80-90% effective. However, some studies report 70-80% and there is a question about whether the WHO analgesic ladder is still valid.
The specialist palliative care team may be involved to manage more complex pain or to offer guidance about the most effective route of administration, ie subcutaneous or parenteral, taking into account the needs of the individual and their choices when possible.
Most analgesia increases the risk of constipation. Careful monitoring of bowel function and titration of laxatives are important to maintain optimal absorption of Parkinson’s medication and the person’s comfort.
Further reading
Analgesic ladder (World Health Organization, 2017)
NICE guideline [CG140] 2012 Palliative care for adults: strong opioids for pain relief. Updated 2016
4.3 The management of physical symptoms