The Pain We Miss: Rethinking Chronic Pain in Parkinson’s Disease

Parkinson’s disease is most often defined by what we can see: tremors, rigidity, and slow movement.

But for many patients, the most disruptive symptom isn’t motor at all, it’s pain. Too often, the pain caused from Parkinson’s disease goes unrecognized.

Pain in Parkinson’s disease is not a secondary complaint. It is a core, multifaceted symptom that affects a significant portion of patients and directly impacts quality of life, function, and clinical outcomes. Yet it remains underreported, underdiagnosed, and frequently undertreated. The challenge is not just that pain exists in Parkinson’s, it’s that we are still learning how to recognize and treat it effectively.

April 11th is World Parkinson’s Day and serves as a reminder that Parkinson’s is more than what we can see, bringing attention to symptoms like pain that continue to be overlooked in clinical care.

More Than a Symptom: Understanding Pain in Parkinson’s

Pain from Parkinson’s is complex because it exists across multiple domains:

Musculoskeletal pain - often driven by rigidity and postural changes
Neuropathic pain - linked to nerve dysfunction
Dystonia-related pain - associated with abnormal muscle contractions
Central pain - rooted in altered pain processing within the brain

The last category, central pain, is where the Parkinson’s pain conversation is heading.

Parkinson’s is fundamentally a neurological disorder, and the same dopaminergic dysfunction that drives motor symptoms also alters how the brain processes pain. Changes in the basal ganglia, thalamus, and other central pathways can amplify pain perception, lower pain thresholds, and distort how sensory input is interpreted.

In some cases, pain may even precede the classic motor symptoms of Parkinson’s. This reframes pain not as a downstream effect, but as part of the disease process itself.

Why Pain Goes Unnoticed

Despite how common it is, pain in Parkinson’s disease often goes unmissed, and there’s a few reasons for this:

1. Clinical focus remains on motor symptoms

Diagnosis, treatment, and follow-up are still largely centered on

movement-related impairments. Non-motor symptoms, including pain, are frequently deprioritized.

2. Pain presentation is inconsistent

Patients may describe pain in vague or non-specific ways. It may fluctuate with medication cycles, disease progression, or activity levels, making it harder to classify.

3. Pain overlaps with other conditions

Musculoskeletal pain, in particular, can be attributed to aging, arthritis, or general deconditioning rather than Parkinson’s itself.

4. Gaps in standardized assessment

Pain is not always systematically evaluated in routine Parkinson’s care, leading to missed opportunities for intervention.

New Approaches to Chronic Pain Care

An understanding of Parkinson’s-related pain evolves, so does the approach to managing it. The most effective strategies are no longer purely pharmacological. Instead, they reflect a multidisciplinary, biopsychosocial model of care.

1. Addressing Central Pain Mechanisms

Recognizing that pain may originate in altered brain signaling, not just peripheral injury, opens the door to new therapeutic strategies, including neuromodulation, cognitive interventions, and targeted pharmacologic approaches.

2. Integrating Behavioral and Psychological Care

Pain perception is influenced by mood, stress, and cognitive factors. Interventions that incorporate behavioral health, patient education, and coping strategies can meaningfully improve outcomes.

3. Expanding Multidisciplinary Collaboration

Effective pain management increasingly involves coordination between neurologists, pain specialists, physical therapists, and integrative care providers. No single discipline can fully address the complexity of Parkinson’s-related pain.

4. Moving Toward Precision and Personalization

Pain in Parkinson’s is highly individualized. Treatment plans must reflect the type of pain, its underlying drivers, and the patient’s functional goals.

This shift represents a move away from reactive care and toward proactive, patient-centered strategies.

Continuing the Conversation at PAINWeek 2026

As pain care continues to evolve, so does the need for education that reflects its complexity.

At PAINWeek 2026, multiple sessions across clinical, behavioral, and multidisciplinary tracks will explore real-world strategies for managing chronic pain, including in neurologically complex populations.

From understanding central pain mechanisms to applying team-based care models, these sessions are designed to move beyond theory and into practical application.

PAINWeek 2026 is your chance to expand your knowledge and enhance your strategies in pain management. This year’s conference includes six specialized educational tracks, including the Behavioral, Psychological, and Social Dimensions of Pain track, which delves into how neurological and behavioral factors shape pain and provides practical tools to improve patient care.

Registration for PAINWeek 2026 is now OPEN! Don’t miss this opportunity to advance your expertise—register today!

Here's the link: https://conference.painweek.org/?_mc=x_pw_x_pw_regl_x_x_x_x_x_aprilblog1_2026

Sources:

https://pmc.ncbi.nlm.nih.gov/articles/PMC8302194/

https://academic.oup.com/braincomms/article/6/4/fcae210/7695860?login=false

https://journals.lww.com/pain/fulltext/2021/04000/the_parkinson_disease_pain_classification_system_.21.aspx

https://www.sciencedirect.com/science/article/pii/S2590112525001082