Am J Psychiatry 1992; 149:1075-1080
Copyright © 1992 by American Psychiatric Association
Painful sensory symptoms in neuroleptic-induced extrapyramidal syndromes
P Decina, S Mukherjee, G Caracci and K Harrison
Department of Psychiatry, New York Hospital-Cornell Medical Center, New York City.
OBJECTIVE: The authors tested the hypothesis that neuroleptic-induced
extrapyramidal syndromes are associated with painful sensations objectively
conforming to the characteristics of primary sensory symptoms as reported
in idiopathic and postencephalitic parkinsonism. METHOD: The frequency of
subjective painful sensory symptoms and their relation to
neuroleptic-induced extrapyramidal syndromes were examined in a consecutive
series of 107 psychiatric patients newly admitted to acute care units at a
teaching hospital. Patients without illnesses or conditions likely to be
associated with pain were included in the study if they had a diagnosis
other than organic mental syndromes and were receiving psychotropic
medications as prescribed by their treating physicians. Structured
interviews with a modified version of the McGill Pain Questionnaire to
assess sensory complaints and neurological examinations for
neuroleptic-induced extrapyramidal syndromes (parkinsonism and akathisia)
were conducted independently by two raters blind to each other's findings
and patients' medication status. RESULTS: Fourteen (23%) of 60 patients
receiving neuroleptics reported experiences of spontaneous pain
subjectively attributed to pharmacological treatment, compared with only
one (2%) of 47 patients receiving psychotropic medications other than
neuroleptics. There was no difference between these two groups in
subjective complaints of paresthesia (8% versus 9%). Twelve (55%) of the 22
patients with neuroleptic-induced extrapyramidal syndromes reported pain,
compared with only two (5%) of the 38 patients who received neuroleptics
but did not experience extrapyramidal syndromes. CONCLUSIONS: Although
consonant with the study hypothesis, these results should be regarded as
preliminary and interpreted conservatively in the light of the
methodological limitations of the study.
