Advances in diagnosis, classification, and management of pain in Parkinson's disease
Open accessAbstract
With over 10 million people affected worldwide, Parkinson's disease is the fastest-growing neurological disorder. More than two-thirds of people with Parkinson's disease live with chronic pain, which can manifest in various stages of the disease, substantially affecting daily activities and quality of life. The Parkinson's disease Pain Classification System overcomes the limitations of previous classification systems by distinguishing between pain related to Parkinson's disease and unrelated pain, while also incorporating clinical and pathophysiological (mechanistic) descriptors such as nociceptive, neuropathic, and nociplastic pain. This system provides a framework for accurate diagnosis and mechanism-based therapy. Alongside the appropriate classification of pain, consideration of treatment approaches that include non-invasive (pharmacological and non-pharmacological) and invasive strategies tailored to specific types of pain will refine and inform research trials and clinical practice when it comes to treating pain in Parkinson's disease.
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In Parkinson's disease, when neuropathic pain is clinically present but a lesion to the somatosensory system cannot be confirmed by objective assessments, the diagnosis is considered probable.
“In Parkinson's disease, it has recently been suggested that when neuropathic pain is clinically present, but a lesion to the somatosensory system cannot be confirmed by objective assessments, the diagnosis is to be considered probable (Tinazzi et al. 2025).”
From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the <scp>NeuPSIG</scp> Algorithm (2026) · cites this paper as Tinazzi et al. 2025
The available passages contain bibliographic details (the passage labeled Abstract, page not given), but no discussion of neuropathic-pain diagnostic criteria. Searches for probable neuropathic pain, somatosensory lesions, and objective assessments found no passage addressing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredPain in multiple sclerosis is rarely exclusively neuropathic and often presents as a co-occurrence of nociceptive and neuropathic pain characteristics, further complicating diagnoses.
“Furthermore, pain in MS is rarely exclusively neuropathic and often presents as a co‐occurrence of nociceptive and neuropathic pain characteristics, further complicating diagnoses (Tinazzi et al. 2025).”
From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the <scp>NeuPSIG</scp> Algorithm (2026) · cites this paper as Tinazzi et al. 2025
The available passages contain bibliographic information identifying this as a review of pain in Parkinson’s disease, but no passage addresses pain in multiple sclerosis. Searches for MS pain and for the claimed co-occurrence of neuropathic and nociceptive characteristics returned no relevant passage, so our copy cannot verify the claim. (LLM, conf=0.75)
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Cites
Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., et al. (2020) · Pain · doi:10.1097/j.pain.0000000000001939 · Cited by 5,223 · see citing works
Bloem, B. R., Okun, M. S., & Klein, C. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00218-x · Cited by 3,920 · see citing works
Chronic pain: an update on burden, best practices, and new advances
Cohen, S. P., Vase, L., & Hooten, W. M. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00393-7 · Cited by 2,614 · see citing works
Neuropathic pain: an updated grading system for research and clinical practice
Finnerup, N. B., Haroutounian, S., Kamerman, P., Baron, R., Bennett, D. L. H., Bouhassira, D., Cruccu, G., Freeman, R., Hansson, P., Nurmikko, T., et al. (2016) · Pain · doi:10.1097/j.pain.0000000000000492 · Cited by 1,332 · see citing works
Nociplastic pain: towards an understanding of prevalent pain conditions
Fitzcharles, M.-A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00392-5 · Cited by 1,253 · see citing works
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Jungersen, R. C., Baccaro, V. K., Hvid, L. G., Dalgas, U., & Hoegh, M. (2026) · European Journal of Pain · doi:10.1002/ejp.70375 · Cited by 1 · see citing works
- Authors
- Tinazzi, M., Gandolfi, M., Artusi, C. A., Bannister, K., Rukavina, K., Brefel-Courbon, C., de Andrade, D. C., Perez-Lloret, S., & Mylius, V.
- Affiliations
- University of Verona (IT)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Imperial College London (GB)
- European Academy of Neurology (AT)
- Philipps University of Marburg (DE)
- Corresponding author
- Gandolfi, Marialuisa
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2025-04
- Volume
- 24
- Issue
- 4
- Pages
- 331-347
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W4408598171
- Cited by
- 60
- References
- 5
- Citations by year
- 2026: 39 · 2025: 21
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- green
- vbn.aau.dk
- Licence
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (publishedVersion, cc-by-nc-nd)
- Conicet (publishedVersion, cc-by-nc-sa)
- Repositorio Institucional UCA (Pontificia Universidad Católica Argentina) (submittedVersion, cc-by-nc-sa)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- Parkinson's disease, chronic pain, pain classification, nociceptive pain, neuropathic pain, nociplastic pain, pain diagnosis, pain management, non-pharmacological treatment, pharmacotherapy, quality of life
- MeSH terms
- Humans, Pain, Pain Measurement, Parkinson Disease, Pain Management
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