Document Type

Open Access Capstone

Publication Date

Summer 7-17-2024

Abstract

Background: Pain is a multifaceted, non-motor symptom often unnoticed and undertreated in Parkinson's disease (PD). PD pain is associated with decreased quality of life (QOL) and is found in 30-85% of PD patients. The effective diagnosis and treatment of PD pain could improve patient QOL. Barriers to appropriate diagnosis and treatment include a valid and reliable PD pain assessment tool. There was an opportunity to improve the assessment of PD-related pain at the movement disorder clinic in this suburban clinic of a tertiary safety net hospital. The local movement disorder clinic did not have a standardized PD-specific tool to assess PD pain. Additionally, the PD patient may not feel the pain related to PD and, therefore, not report pain which may result in unnecessary patient suffering.

Methods: A PRISMA-guided literature review was undertaken to determine the most effective pain scales to assess pain in individuals with PD. The King’s Parkinson’s Pain Questionnaire (KPPQ) was identified as a reliable and valid self-rated screening tool. The aim was to implement and evaluate KPPQ, a self-screening tool to serve as a streamlined process to trigger discussion for assessing Parkinson’s disease-specific pain.

Intervention: The KPPQ, a self-screening tool, was implemented for PD patients in the outpatient movement disorder clinic. PD patients were asked to complete the tool and providers reviewed the pain screening tool to assess pain further. If any discussion of pain occurred between the patient and provider, it was to be noted in the chart. Later, a chart audit evaluated if the patients with pain had a pain discussion documented in the chart. Analysis of the assessment of PD pain was informed by those who completed the self-screening KPPQ tool for pain and those with pain who discussed it with the clinician. Completed screening tools identified this population's most often to least reported PD-specific type of pain. Huddles that took place throughout the project provided qualitative data vis-à-vis the clinic team’s observations and opinions regarding the project and process. The clinic staff's post-implementation survey identified the project's satisfaction, feasibility, and added value.

Results: Most of the PD patients who completed the self-reported screening conveyed pain in this outpatient movement disorder clinic. Musculoskeletal pain was reported most often, followed by painful muscle cramps, and pain related to turning in bed during the night. Pain assessment improved, with most PD pain patients engaged in discussions as compared to prior to the implementation of the tool.

Conclusions: This project established a process flow utilizing the KPPQ screening tool to identify PD-related pain. The overwhelming prevalence of pain in this population highlights the importance of self-report of pain in PD patients. Clinic staff recognized that further assessment of PD-specific pain allows for an opportunity to improve patient care.

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