Pain in
Parkinson's disease (PD) is a debilitating symptom with a prevalence of 68%, yet is untreated 50% of the time. What is unclear, however, is which treatment is optimal for minimizing
pain severity in PD. Thus, the objective of this systematic review and meta-analysis was to investigate the efficacy of a variety of novel, complimentary, and conventional treatments for
pain in PD and elucidate which
therapy is the most effective. A systematic search was performed using MEDLINE, PsycINFO, Embase, CINAHL, and CENTRAL databases. To identify additional articles, manual searches of reference lists of included trials were also searched. Major neurology conference proceedings occurring between January 2014 and February 2018 were also searched to identify unpublished studies that may be potentially eligible. Twenty-five randomized controlled trials that encompassed medical, surgical, and
complementary therapies met our inclusion criteria and exhibited moderate quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. A conservative random-effects model was used to pool effect estimates of
pain severity. The greatest reductions in
pain were found with
safinamide (Standardized mean difference = -4.83, 95% CI [-5.07 to -4.59], p < 0.0001), followed by
cannabinoids and
opioids, multidisciplinary team care,
catechol-O-methyltransferase inhibitors, and electrical and Chinese
therapies. Moderate effects in reducing
pain were in
pardoprunox and surgery, while the weakest effects were in
dopaminergic agonists and miscellaneous
therapies.
Safinamide is an important adjunct to standard parkinsonian medication for alleviating
pain in PD.