Department of Neurology, Columbia University, New York, NY, USA.
CNS Drugs. 2012 Nov;26(11):937-48. doi: 10.1007/s40263-012-0005-2.
Pain is a common symptom in Parkinson's disease (PD) and accounts for substantial morbidity in up to 80 % of patients. Despite contributing to disease-related discomfort and disability, pain in PD frequently goes underacknowledged and undertreated in clinical practice. Although the exact underlying neurophysiology is unclear, there is increasing understanding of the role of the basal ganglia in somatosensory processing, as well as involvement of additional brainstem structures and non-dopaminergic pathways; appreciation of these mechanisms has implications for treatment strategies. Categorizing painful symptoms based on their clinical description into musculoskeletal, dystonic, radicular-peripheral neuropathic and central pain categories provides a useful framework for management. Importantly, these symptoms should be evaluated in relation to motor symptoms and dopaminergic therapy. A multi-disciplinary approach is recommended as follows: physical therapy, liaison with pain management and consultations to rheumatological, orthopaedic and neurosurgical services should be considered.
疼痛是帕金森病（PD）的常见症状，高达 80%的患者因此出现大量的发病率。尽管疼痛导致了与疾病相关的不适和残疾，但在临床实践中，PD 患者的疼痛常常被低估和治疗不足。尽管确切的潜在神经生理学机制尚不清楚，但人们越来越了解基底神经节在躯体感觉处理中的作用，以及脑干结构和非多巴胺能通路的参与；对这些机制的认识对治疗策略有影响。根据临床描述将疼痛症状分为肌肉骨骼、肌张力障碍、神经根-周围神经病理性和中枢性疼痛类别，为管理提供了一个有用的框架。重要的是，这些症状应与运动症状和多巴胺能治疗相关进行评估。建议采取多学科方法，如下所示：物理治疗、与疼痛管理的联系以及对风湿病、骨科和神经外科服务的咨询。
