Vol 16, No 2 (2022)
Review paper
Published online: 2022-03-29

open access

Page views 4581
Article views/downloads 511
Get Citation

Connect on Social Media

Connect on Social Media

Pharmacological treatment of palliative care patients with Parkinson’s disease

Zbigniew Zylicz1
Palliat Med Pract 2022;16(2):117-122.


Parkinson’s disease is the commonest neurodegenerative condition, which can be eased for a long
while, however, it inevitably leads to patients’ death. Dying with Parkinson’s disease can be problematic
as the clinical situation may change dynamically and necessitate frequent drug dose changes and the
introduction of new, preferably injectable, drugs may be necessary. Current treatment of Parkinson’s
disease aims to increase the brain’s dopamine focusing mainly on the motor symptoms. The patients
suffer frequently from sudden “on” and “off” fluctuations of muscle rigidity accompanied by extreme
pain. Classic dopaminergic treatments wear off and become ineffective. The new drug safinamide has
been introduced recently with a promising effect on motor and non-motor symptoms including pain.
If unavailable, opioids or cannabinoids to relax muscles are the second-best choice. Also, non-motor
symptoms like depression, delirium and psychosis may dominate in dying which necessitates antipsychotic
treatment with clozapine or quetiapine even if these drugs may hasten deterioration and result in death.

Article available in PDF format

View PDF Download PDF file


  1. Pringsheim T, Jette N, Frolkis A, et al. The prevalence of Parkinson's disease: a systematic review and meta-analysis. Mov Disord. 2014; 29(13): 1583–1590.
  2. Baker MG, Graham L. The journey: Parkinson's disease. BMJ. 2004; 329(7466): 611–614.
  3. Ross GW, Abbott RD. Living and dying with Parkinson's disease. Mov Disord. 2014; 29(13): 1571–1573.
  4. Macleod AD, Taylor KSM, Counsell CE. Mortality in Parkinson's disease: a systematic review and meta-analysis. Mov Disord. 2014; 29(13): 1615–1622.
  5. Moens K, Houttekier D, Van den Block L, et al. Place of death of people living with Parkinson's disease: a population-level study in 11 countries. BMC Palliat Care. 2015; 14: 28.
  6. Kalia L, Lang A. Parkinson's disease. The Lancet. 2015; 386(9996): 896–912.
  7. Schrag A, Horsfall L, Walters K, et al. Prediagnostic presentations of Parkinson's disease in primary care: a case-control study. Lancet Neurol. 2015; 14(1): 57–64.
  8. Alty J, Robson J, Duggan-Carter P, et al. What to do when people with Parkinson's disease cannot take their usual oral medications. Pract Neurol. 2016; 16(2): 122–128.
  9. Goy ER, Bohlig A, Carter J, et al. Identifying predictors of hospice eligibility in patients with Parkinson disease. Am J Hosp Palliat Care. 2015; 32(1): 29–33.
  10. Thomas S, MacMahon D. Parkinson's disease, palliative care and older people: Part 1. Nurs Older People. 2004; 16(1): 22–26.
  11. Hudson PL, Toye C, Kristjanson LJ. Would people with Parkinson's disease benefit from palliative care? Palliat Med. 2006; 20(2): 87–94.
  12. Lee MA, Prentice WM, Hildreth AJ, et al. Measuring symptom load in Idiopathic Parkinson's disease. Parkinsonism Relat Disord. 2007; 13(5): 284–289.
  13. Higginson IJ, Gao W, Saleem TZ, et al. Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors. PLoS One. 2012; 7(11): e46327.
  14. Hinnell C, Hurt CS, Landau S, et al. PROMS-PD Study Group. Nonmotor versus motor symptoms: how much do they matter to health status in Parkinson's disease? Mov Disord. 2012; 27(2): 236–241.
  15. Valkovic P, Minar M, Singliarova H, et al. Pain in Parkinson's Disease: A Cross-Sectional Study of Its Prevalence, Types, and Relationship to Depression and Quality of Life. PLoS One. 2015; 10(8): e0136541.
  16. Martin SL, Jones AKP, Brown CA, et al. A neurophysiological investigation of anticipation to pain in Parkinson's disease. Eur J Neurosci. 2020; 51(2): 611–627.
  17. Vila-Chã N, Cavaco S, Mendes A, et al. Unveiling the relationship between central parkinsonian pain and motor symptoms in Parkinson's disease. Eur J Pain. 2019; 23(8): 1475–1485.
  18. Bianchi ML, Riboldazzi G, Mauri M, et al. Efficacy of safinamide on non-motor symptoms in a cohort of patients affected by idiopathic Parkinson's disease. Neurol Sci. 2019; 40(2): 275–279.
  19. Qureshi AR, Rana AQ, Malik SH, et al. Comprehensive Examination of Therapies for Pain in Parkinson's Disease: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2018; 51(3-4): 190–206.
  20. Zylicz Z. Peripheral Nerve Blocks in Palliative Care for Cancer Patients. Peripheral Nerve Entrapments. 2016: 79–84.
  21. Iwamoto N, Isu T, Kim K, et al. Low Back Pain Caused by Superior Cluneal Nerve Entrapment Neuropathy in Patients with Parkinson Disease. World Neurosurg. 2016; 87: 250–254.
  22. Broetz D, Eichner M, Gasser T, et al. Radicular and nonradicular back pain in Parkinson's disease: a controlled study. Mov Disord. 2007; 22(6): 853–856.
  23. Jenner P, Katzenschlager R. Apomorphine – pharmacological properties and clinical trials in Parkinson's disease. Parkinsonism Relat Disord. 2016; 33 Suppl 1: S13–S21.
  24. Rabinak CA, Nirenberg MJ. Dopamine agonist withdrawal syndrome in Parkinson disease. Arch Neurol. 2010; 67(1): 58–63.
  25. Yu XX, Fernandez HH. Dopamine agonist withdrawal syndrome: A comprehensive review. J Neurol Sci. 2017; 374: 53–55.
  26. Psychosis in Parkinson's disease. Ann Indian Acad Neurol. 2011; 14(Suppl 1): S16–17.
  27. Merims D, Balas M, Peretz C, et al. Rater-blinded, prospective comparison: quetiapine versus clozapine for Parkinson's disease psychosis. Clin Neuropharmacol. 2006; 29(6): 331–337.
  28. Schrag A, Quinn N. Dyskinesias and motor fluctuations in Parkinson's disease. A community-based study. Brain. 2000; 123 ( Pt 11): 2297–2305.
  29. Tomlinson CL, Stowe R, Patel S, et al. Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord. 2010; 25(15): 2649–2653.
  30. Dewhurst F, Lee M, Wood B. The pragmatic use of apomorphine at the end of life. Palliat Med. 2009; 23(8): 777–779.
  31. Xu Xp, Yu Xy, Wu Xi, et al. Propofol requirement for induction of unconsciousness is reduced in patients with Parkinson's disease: a case control study. Biomed Res Int. 2015; 2015: 953729.

Palliative Medicine in Practice