Pain in the Neurodegenerating Brain

Insights Into Pharmacotherapy for Alzheimer Disease and Parkinson Disease

Timothy Lawn; Yahyah Aman; Katarina Rukavina; George Sideris-Lampretsas; Matthew Howard; Clive Ballard; Kallol Ray Chaudhuri; Marzia Malcangio


Pain. 2021;162(4):999-1006. 

In This Article


Pain processing is altered in both AD and PD, but research to date has been focussed on evoked pain. During chronic pain, structural and functional reorganisation that takes place can be conceptualised as normal pain processing by the nervous system interacting with a given aetiology to produce a novel chronic pain brain state.[146] These perturbed states further interact with neurodegenerative pathophysiology in a manner yet to be investigated; whether this produces differential responses to analgesic pharmacotherapy to those seen in the general population remains unclear. However, the theoretical basis outlined here is compelling and mechanistic-level investigation will be crucial to translate our emerging understanding of dysfunctional pain processing to inform safe and effective clinical management. Although our focus here has been on AD and PD, these constructs likely extend to other neurodegenerative diseases that require similar mechanism-based investigation to facilitate therapeutic development.