Stage 1 of Parkinson’s Disease (Mild)

• Symptoms are mild and may only affect one side.
• Daily functioning is not impaired although tremors create difficulty.
• Slightly evident changes in balance, posture, movement and facial expression.

Stage 2 of Parkinson’s Disease (Moderate)

• Symptoms are bilateral – affecting both sides.
• Mild difficulty in movement – walking, balance and posture.
• Impairment in completing daily physical activities.

Stage 3 of Parkinson’s Disease (Difficult)

• Difficulty in maintaining balance and posture.
• Impairment of walking or standing although sufferer is usually able to do so independently.
• Physical movements are noticeably slow.

Stage 4 of Parkinson’s Disease (Severe)

• Unable to maintain balance or posture.
• Instability when walking or standing and requires assistance.
• Tremors usually reduce in this stage although independent completion of daily physical tasks is usually not possible.

Stage 5 of Parkinson’s Disease (Advanced)

• Almost complete inability to function independently.
• Walking or standing usually not possible.
• Constant attention and nursing care required.
• Confusion, dementia and other mental disturbances may occur in some cases.

Differentiating stages of Parkinson’s varies among cases, with certain individuals showing signs of two stages simultaneously. Therefore the guideline is intended to outline and identify the progression of the disease in accordance with level of functioning rather than the onset of symptoms of Parkinson’s disease. In certain cases, a Parkinson’s sufferer may skip the first two stages especially if the condition was not being monitored closely. However the slow progression of Parkinson’s disease means that the shift to the latter stages does not occur overnight and may be delayed with effective treatment.

Dexterity and coordination are the primary factors for daily functioning in the life of a Parkinson’s sufferer. Changes in either factor may affect individual Parkinson’s sufferers to varying degrees with some coping better than others. However with time, the level of dexterity and coordination is sufficiently impaired to render Parkinson’s disease sufferers incapable of taking care of themselves.

When we think about the symptoms of Parkinson’s disease people often associate it with the more common symptoms such as stiffness in the joints, slowness of movement and poor mobility. There are however other symptoms which can be just as debilitating but which don’t show outwardly, pain is one of them.

Most sufferers of this disease will admit to having painful symptoms and have some form of painful discomfort on a daily basis, in fact this symptom can become so severe that other symptoms of the disease are overshadowed, yet it is a symptom which is very often overlooked by people in general.

Pain and discomfort associated with Parkinson’s disease is brought about either due to musculoskeletal problems brought on by poor posture, or brought on by Dystonia which is the twisting of a muscle group or body part and discomfort due to severe restlessness.

Musculoskeletal pain

Aching muscles and joints are a common side effect in someone with Parkinson’s disease, lack of movement and abnormal posture all contribute to this. One of the most common forms of musculoskeletal pain is stiffness in the shoulder which is often termed frozen shoulder; hip, back and neck pain are also common symptoms in the disease.

For the diagnosis of musculoskeletal pain to be accurate a careful history of the patient must be taken and a physical examination will be made to determine posture, limb rigidity and gait. Further testing may also be necessary which could include e-rays, bone scans, ultra sound and orthopaedic consultations. Treatment for the pain will depend on whether the pain is due to excessive immobility or rigidity.

Pain caused by Dystonia

Pain associated with Dystonic spasms are usually amongst the most painful symptoms that sufferers of Parkinson’s will encounter. This type of pain is brought about due to the forceful, twisting posture which Dystonia bring about. Dystonia will affect the limbs, trunk, neck, face, jaw, swallowing muscles and vocal chords of the sufferer, one of the most common and painful symptoms is the curling of the toes and feet.

The most important step in diagnosing pain which is due to Dystonia is establishing its relationship to dopaminergic medication prescribed for Parkinson’s. For example does this occur when the medicine reaches peak effect or when it is wearing off?

Treatment for pain relating to Dystonia will vary; early morning treatment can be exercise or be relieved by taking medication. People who suffer from intractable Dystonia may benefit from deep brain stimulation which involves implanting electrodes in the brain and activating them.