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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18892
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Good morning, my 86 year old father has Parkinsons Disease.

Resolved Question:

Good morning, my 86 year old father has Parkinsons Disease. He is currently in temporary nursing home accommodation following an admission to hospital for pneumonia from which he has recovered. However, he has not returned to the physical form he was in prior to his hospital admission. In fact, he can't stand, let alone walk, whereas he was getting about before, albeit with a shuffling gait. But the main worry is the pain he is experiencing in his feet which the nurse thinks is peripheral neuropathy. I have researched Parkinsons pain and know a bit about it all but my question is this: My Dad has his last Sinemet when he goes to bed at around 9.30 pm and although it is a slow release, he is waking in pain and agitation all through the night. When we visited yesterday afternoon he was the same so I'm not sure what's going on. He has a hospital appointment on the 30th of this month but that seems a lifetime away for him when he is suffering so much. Could you suggest anything in the meantime? Many thanks Lorraine XXXXX

Submitted: 4 years ago.
Category: Medical
Expert:  Dr. D. Love replied 4 years ago.
I'm sorry that your father is having such difficulty.
What dose of Sinemet is he taking?

Customer: replied 4 years ago.

All his meds are at the nursing home I'm afraid so I'm not sure. I know that he has two Sinemet at 6 am with Entacapone, then one at 9 am, two at noon with Entacapone, one at 3pm, 2 at 5pm with Entacapone and then one slow release at 9.30 when he goes to bed

Expert:  Dr. D. Love replied 4 years ago.
Thank you for the additional information.

There are several considerations when trying to address pain management in someone with Parkinson disease. Most people with Parkinson disease can have pain as one of the problem associated with the disease, either as a primary complication of the illness or indirectly associated with it.

I ask about the medicine dose because poor control of the motor symptoms of Parkinson disease is one of the common causes of pain, so it is appropriate to consider whether the dose of Sinemet or entacapone can be adjusted. Without knowing the current dose of the Sinemet, it is difficult to say whether the dose could be adjusted, but you could check with the nursing home. Another option would be whether to increase the dose of entacapone, and particularly whether to give a dose of entacapone with the bedtime dose of Sinemet.

It is true that there is an increased risk of a peripheral neuropathy in persons with Parkinson disease. There are a number of drugs that can be used for peripheral neuropathy, but the common medicines require prescriptions, and the one medicine that is available over the counter, capsaicin cream, usually takes a couple weeks to accumulate in the body to be effective, so will not provide any quick relief prior to the visit on the 30th.

It certainly would be OK to use paracetamol for the pain, but this may have already been tried. The local application of moist heat or massage may also be helpful, although any use of heat in someone with a peripheral neuropathy should be monitored by someone with intact sensation, as the peripheral neuropathy may impair perception of whether it is getting too hot.

If you have any further questions, please let me know.

Expert:  Dr. D. Love replied 4 years ago.
This question was added to the list as though there was a follow-up question. I do not see any further questions, so I have no additional information beyond the above answer, but the system will require that I respond. If a follow-up question was lost, please ask it again.

Customer: replied 4 years ago.

I think my follow up question was lost. Thank you for your previous response. I am happy with your reply although my Dad is finding it difficult to recover from his bout of pneumonia and maybe his body will be too frail to cope. Thank you again for your help.

Best wishes

Lorraine XXXX

Expert:  Dr. D. Love replied 4 years ago.
I'm sorry that the system lost the follow-up question. If you would like to repeat it, I would be glad to address it.

If your question was about frailty and recovery from pneumonia, unfortunately, that is fairly common. Just from his age alone, the ability to recover from a major illness will be slower, and when there is also a major chronic illness, such as Parkinson disease, that will further hamper recovery. However, the rehab programs offered in these facilities is typically the best approach to support recovery.

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