DEAR DR. GOTT: I am a 53-year-old female diagnosed with Parkinson’s disease. Family history of tremor but no one was ever diagnosed with PD. My symptoms are all on the right side which include gait disturbance and a tremor in my hand and foot. I had a DaT scan which came back abnormal, showing a dopamine deficiency. The most puzzling aspect is that I have chronic back pain between my shoulder blades which radiates into my neck. It is so severe that I cannot work.
The neurologist said that the med (Mirapex) should help with the pain if it is related to my PD. I have been on the med for three months with no relief. I have tried physical therapy, acupuncture and steroid shots. The physiatrist is now sending me for an EMG of my upper right extremity to rule out that it is nerve related.
My question is, how do I know if the back pain is part of the Parkinson’s or if it is a separate issue? Am I on the right path?
DEAR READER: As background for other readers, Parkinson’s disease (PD) is a progressive neurological movement disorder that affects almost one million people in our country. Neurons in the brain of a healthy individual produce a chemical known as dopamine that sends messages to the portion of the brain that controls coordination and movement. With PD, insufficient dopamine is produced and the individual is unable to control his or her movements in the normal manner. Signs and symptoms vary from person to person.
One of the most common signs is a resting tremor of the fingers or one or both of the hands. You may experience “pill rolling”, the circular movement of two fingers rubbing together. Muscle rigidity can occur, limiting range of motion that will cause problems standing, sitting, or walking with ease. You may develop a vacant stare and seemingly be without expression. Your thoughts may be slowed and your handwriting may become cramped and illegible. You may require a cane, walker, or wheel chair. Gait abnormalities are common; the length of your steps may shorten, you may shuffle your feet and your arms may not swing when you walk. It may be necessary to remove obstacles such as scatter rugs from around your home and the mats from your bathroom to prevent tripping.
I’m sure all of this sounds ominous but for many it’s likely symptoms will be well-controlled for years on medication with minimal effect on your daily living. I know one gentleman in his 60s with PD who goes to work every morning, rarely misses a dance or social event in town and manages very well. So, while symptoms may progress, the process does not occur all at once.
While back pain isn’t common, your muscles may be extremely tight, causing the pain between your shoulder blades. I’d be surprised if the pain is PD related but believe you are on the right track with acupuncture. You should follow up on other avenues for the problem but if appropriate, may even want to include physical therapy that can be done at your local hospital or at home, yoga, tai chi or even water aerobics.
Scientists are investigating the brain’s correlation to such non-motor functions as sleep regulation and the sense of smell. The presence of Lewy bodies could be the reason these senses become modified – even before any motor signs of PD appear. This brings me to question whether Parkinson’s, Lewy body dementia and Alzheimer’s are manifestations of one disease and more closely related than we have been led to believe. Perhaps the areas of the brain that are affected determine those symptoms experienced.
While there is no cure for Parkinson’s at this time, excellent treatment options are available. They include levodopa and other medications, or surgery such as deep brain stimulation when medication fails to control symptoms. Keep in mind that surgery is only effective for some individuals who may meet specific criteria.
Readers who would like related information can order my Health Reports “Parkinson’s Disease” and “Alzheimer’s Disease” by sending $2 (for each report) in the form of a check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.