Department of Neurology, Division of Movement Disorders, Hospital Universitario Fundación Alcorcón, ACalle Budapest s/n, lcorcón, Madrid, Spain.
Parkinsonism Relat Disord. 2012 Sep;18(8):953-7. doi: 10.1016/j.parkreldis.2012.04.031. Epub 2012 May 30.
Study results evaluating pain thresholds in patients with Parkinson's disease (PD) vary widely. Thus, we designed our study to determine the effects of levodopa on the thresholds of pressure (PPT), heat (HPT) and cold pain (CPT) in PD patients with motor fluctuations (18 patients: 10 men, 8 women; age: 65 ± 10 years; mean disease duration: 11.6 ± 6 years), six of whom (33%) reported pain related to their disease. We compared these thresholds in patients in the ON and OFF states with those in 18 age- and sex-matched controls. Pain thresholds were assessed over: the frontal bones, C5-C6 zygapophyseal joints and second metacarpals (PPT); the dorsal aspect of the hand (HPT and CPT); and the tibialis anterior (TA) muscles. PD patients in the OFF state had lower PPT thresholds at all sites (P < 0.001) than healthy controls. Moreover, HPT and CPT thresholds were lower at all sites except over the TA muscle (P < 0.01). In the ON state, the PPT and CPT thresholds in PD patients were lower than in controls at all points, except over the TA (CPT) and the second metacarpals (PPT) P < 0.01. Pain thresholds were no different in PD patients in the ON or OFF state (P > 0.10), and the existence of pain did not influence the results. We detected mechanical and thermal pain hypersensitivity in PD patients in the OFF state, and levodopa administration did not increase these thresholds. Thus, while dopamine may modulate pain responses, other mechanisms are likely to be implicated in the modulation of these pain responses in PD patients.
研究结果表明，帕金森病（PD）患者的疼痛阈值评估差异较大。因此，我们设计了本研究以确定运动波动的 PD 患者（18 名患者：10 名男性，8 名女性；年龄：65±10 岁；平均病程：11.6±6 年）中左旋多巴对压力阈值（PPT）、热阈值（HPT）和冷痛阈值（CPT）的影响，其中 6 名（33%）患者报告了与疾病相关的疼痛。我们将这些阈值与患者的 ON 和 OFF 状态以及 18 名年龄和性别匹配的对照组进行了比较。疼痛阈值评估在以下部位进行：额骨、C5-C6 椎间关节和第二掌骨（PPT）；手部背面（HPT 和 CPT）；和胫骨前肌（TA）。处于 OFF 状态的 PD 患者在所有部位的 PPT 阈值均较低（P<0.001），与健康对照组相比。此外，除了 TA 肌肉外，所有部位的 HPT 和 CPT 阈值均较低（P<0.01）。在 ON 状态下，PD 患者的 PPT 和 CPT 阈值在除了 TA（CPT）和第二掌骨（PPT）以外的所有部位均低于对照组（P<0.01）。PD 患者在 ON 或 OFF 状态下的疼痛阈值无差异（P>0.10），且疼痛的存在并不影响结果。我们在 OFF 状态下检测到 PD 患者的机械和热痛敏感性增加，而左旋多巴给药并未增加这些阈值。因此，尽管多巴胺可能调节疼痛反应，但其他机制可能参与了 PD 患者疼痛反应的调节。
