Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea.
Department of Neurology and Movement Disorder Center, Parkinson Study Group, Seoul National University Hospital, Seoul, Korea.
JAMA Neurol. 2015 May;72(5):504-10. doi: 10.1001/jamaneurol.2015.8.
Pain is a common and distressing feature in Parkinson disease (PD). The major indication of subthalamic nucleus deep brain stimulation (STN DBS) is motor complications in advanced PD; however, pain reduction after STN DBS has been noted.
To evaluate the long-term effect of STN DBS on pain in PD.
DESIGN, SETTING, AND PARTICIPANTS: Twenty-four patients who underwent STN DBS at the Movement Disorder Center at Seoul National University Hospital from June 1, 2005, through March 31, 2006, were studied. The assessments of pain were performed preoperatively and 8 years after surgery. Because 13 of the total 24 patients had additional 2-year postoperative data, the serial change between the preoperative and the 2- and 8-year follow-ups after surgery was also evaluated.
Motor symptoms were assessed using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr staging scale. The severity of pain was scored according to an ordinal scale ranging from 0 (absent) to 10 (maximal pain) in 7 parts of the body (head, neck, trunk, and the upper and lower extremities on each side of the body). For each body part, the quality of pain was grouped into 1 of 4 categories: dystonic, musculoskeletal, radiculoneuritic, and central.
Sixteen of the 24 patients (67%) experienced pain at baseline when not taking medication (off-state). All off-state pain at baseline improved or disappeared at 8 years after surgery. The number of body parts with pain was 21 at baseline and decreased to 11 at 8 years after the surgery. The mean (SD) and median scores of the off-state pain were 6.2 (2.5) and 7.0 at baseline and improved to 3.5 (2.2) and 2.5 at 8 years after the surgery, respectively. However, new pain developed in 18 of 24 patients (75%) during the 8-year follow-up period. The number of body parts with newly developed pain was 47, and the mean (SD) and median scores for new pain were 4.4 (3.0) and 3.0, respectively. The types of new pain at 8 years were musculoskeletal in 11 patients, central in 4 patients, radiculoneuritic in 3 patients, and dystonic in 1 patient.
Pain associated with PD is improved by STN DBS, and the beneficial effect persists after a long-term follow-up of 8 years. In addition, new pain, especially the musculoskeletal type, developed in most patients, becoming a long-term distressing problem.
疼痛是帕金森病（PD）的常见且令人痛苦的特征。丘脑底核深部脑刺激（STN DBS）的主要指征是晚期 PD 中的运动并发症；然而，已经注意到 STN DBS 后疼痛减轻。
评估 STN DBS 对 PD 疼痛的长期影响。
设计、地点和参与者：2005 年 6 月 1 日至 2006 年 3 月 31 日，在首尔国立大学医院运动障碍中心接受 STN DBS 的 24 名患者接受了研究。在术前和术后 8 年进行了疼痛评估。由于 24 名患者中有 13 名患者有额外的术后 2 年数据，因此还评估了手术前后 2 年和 8 年随访之间的连续变化。
使用统一帕金森病评定量表和 Hoehn 和 Yahr 分期量表评估运动症状。根据身体 7 个部位（头部、颈部、躯干和身体两侧的上下肢）的 0（不存在）至 10（最大疼痛）的序数量表对疼痛严重程度进行评分。对于每个身体部位，疼痛的质量分为 4 类之一：张力障碍、肌肉骨骼、神经根性和中枢性。
24 名患者中有 16 名（67%）在未服药（停药状态）时基线时有疼痛。所有基线时的停药状态疼痛均在术后 8 年得到改善或消失。基线时身体部位疼痛的数量为 21 个，术后 8 年减少到 11 个。停药状态疼痛的平均（SD）和中位数评分分别为基线时的 6.2（2.5）和 7.0，术后 8 年分别改善至 3.5（2.2）和 2.5。然而，在 8 年的随访期间，24 名患者中有 18 名（75%）出现新的疼痛。新出现疼痛的身体部位数量为 47 个，新出现疼痛的平均（SD）和中位数评分分别为 4.4（3.0）和 3.0。8 年后新出现的疼痛类型为肌肉骨骼 11 例，中枢性 4 例，神经根性 3 例，张力障碍性 1 例。
PD 相关疼痛通过 STN DBS 得到改善，并且在 8 年的长期随访后仍保持有益效果。此外，大多数患者出现新的疼痛，尤其是肌肉骨骼类型的疼痛，成为长期困扰的问题。
