Klinik für Neurologie, Christian-Albrechts-Universität Kielm, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, Haus 41, 24105 Kiel, Germany. g.wasner@ neurologie.uni-kiel.de
Nat Rev Neurol. 2012 Apr 17;8(5):284-94. doi: 10.1038/nrneurol.2012.54.
Pain is a nonmotor symptom that substantially affects the quality of life of at least one-third of patients with Parkinson disease (PD). Interestingly, patients with PD frequently report different types of pain, and a successful approach to distinguish between these pains is required so that effective treatment strategies can be established. Differences between these pains are attributable to varying peripheral pain mechanisms, the role of motor symptoms in causing or amplifying pain, and the role of PD pathophysiology in pain processing. In this Review, we propose a four-tier taxonomy to improve classification of pain in PD. This taxonomy assigns nociceptive, neuropathic and miscellaneous pains to distinct categories, as well as further characterization into subcategories. Currently, treatment of pain in PD is based on empirical data only, owing to a lack of controlled studies. The facultative symptom of 'dopaminergically maintained pain' refers to pain that benefits from antiparkinson medication. Here, we also present additional pharmacological and nonpharmacological treatment approaches, which can be targeted to a specific pain following classification using our taxonomy.
疼痛是一种非运动症状，至少影响三分之一的帕金森病 (PD) 患者的生活质量。有趣的是，PD 患者常报告不同类型的疼痛，因此需要一种成功的方法来区分这些疼痛，以便制定有效的治疗策略。这些疼痛的差异归因于不同的外周疼痛机制、运动症状在引起或加剧疼痛中的作用以及 PD 病理生理学在疼痛处理中的作用。在这篇综述中，我们提出了一个四层次分类法来改善 PD 中的疼痛分类。该分类法将伤害性疼痛、神经性疼痛和杂类疼痛分配到不同的类别，并进一步细分为亚类。目前，PD 中疼痛的治疗仅基于经验数据，因为缺乏对照研究。“多巴胺维持的疼痛”这一可选症状是指受益于抗帕金森病药物的疼痛。在这里，我们还提出了其他药理学和非药理学治疗方法，可以根据我们的分类法针对特定疼痛进行靶向治疗。
