Objective: To evaluate the effect and safety of subcutaneous apomorphine as a treatment for fluctuation-related pain in Parkinson’s disease (PD).

Background: Pain is one of the most frequent symptoms with up to 85 % of PD patients experiencing pain. It is also a less recognized and often undertreated symptom. Fluctuation-related pain is a debilitating symptom with usually suboptimal response to adjustments in levodopa doses.

Method: We conducted a small one-visit pilot, double-blind, placebo-controlled, randomized crossover trial evaluating the safety and efficacy of subcutaneous apomorphine vs. placebo injections on fluctuation-related PD pain. Primary outcomes: change in a Visual Analogue Scale (VAS) for pain and MDS-UPRDS III. Secondary outcomes: change in patient rated Clinical Global Impression (CGI) and adverse events. Inclusion criteria: subjects with PD who are on antiparkinsonian medications and experiencing pain in their OFF periods. Exclusion criteria: impossibility to self-report pain severity, dementia, poorly controlled orthostatic hypotension, prolonged QT or severe medical conditions. SPSS was used to analyze VAS and UPDRS III scores for each treatment using Friedman’s Two-Way analysis of Variance. Pairwise comparisons were made with Bonferroni’s correction, and McNamar’s Chi-Squared test was used to examine the association between CGI- scores and adverse event frequency in both treatment arms.

Results: Sixteen patients were screened and 11 completed the study. All participants reported fluctuation-related pain as measured by King’s Parkinson’s Pain Scale, with a mean score of 15.0 ± 5.8. The mean VAS pain score for this population at baseline is 7.5 ± 1.3. The mean VAS scores show a consistent reduction in mean self-reported pain over time in apomorphine visit (p = 0.001), which was not seen in control visit (p = 0.5). There was a significant change in UPDRS-III scores over time for the apomorphine visit (p = 0.014). Apomorphine was significantly associated with an improvement in pain in the patient-rated CGI (p = 0.04). There were no significant differences between the occurrence of adverse events.

Conclusion: Fluctuation-related pain in PD is a source of distress and disability to PD patients’ quality of life. In this small pilot study, we report a significant change in both primary and secondary outcomes suggesting a potential specific role for apomorphine as a treatment for this pain subtype.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apomorphine-effects-on-parkinsons-disease-fluctuation-related-pain-a-pilot-study/