Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Clinical Neuroscience, Karolinska Institutet, Solnavägen 1, 171 77 Solna/Stockholm, Sweden.
J Neurol. 2017 Apr;264(4):758-769. doi: 10.1007/s00415-017-8426-y. Epub 2017 Feb 27.
We aimed to evaluate prevalence, phenotype, and therapeutic realities of pain in patients with Parkinson disease (PD). Therefore, we assessed 181 outpatients with PD using a cross-sectional approach applying the German Pain Questionaire (DSF), the PainDetect, and a self-developed Parkinson Disease Pain Questionaire (UPDPQ) covering detailed therapeutic aspects. Furthermore, we investigated the association between pain and PD-disease characteristics, quality of life (PDQ-39), depression, and anxiety (HADS-D, HADS-A). Overall, prevalence of pain was high (95.4%); 91.1% suffered from chronic pain, but in only 22.3% of them, pain disorder was diagnosed. Pain impaired everyday-life moderately to very severely in 48.4% of patients and was the most distressing symptom in 10.2% of all patients. Pain was localized mainly in the back (71.4%) or joints (52.4%), frequently occurred as pain attacks (79%) but appeared with neuropathic character in only 15.3% of patients. Most patients (74.2%) received some kind of pain treatment, mainly provided by orthopedists (62.0%) or general practitioners (50.0%). Physiotherapy (61.3%), pain killers (54.4%), or massage (35.5%) were the most frequent therapeutic measures. Rehabilitative therapy (96.3%) and physiotherapy (89.5%) were rated as most effective, but with vastly temporary effects. 53.3% of patients attributed PD as the main cause for their pain, but only 33.6% found relief from anti-parkinsonian drugs. High levels of pain were associated with higher scores of depression and anxiety, and lower quality of life. Results suggest that pain in PD is frequent, complex, and quality-of-life-impairing but under-diagnosed and unsystematically treated and indicate need to systematically investigate pathophysiology-based treatment strategies.
我们旨在评估帕金森病（PD）患者疼痛的患病率、表型和治疗现状。因此，我们采用横断面研究方法，使用德国疼痛问卷（DSF）、疼痛检测和我们自行开发的涵盖详细治疗方面的帕金森病疼痛问卷（UPDPQ）评估了 181 名门诊 PD 患者。此外，我们还研究了疼痛与 PD 疾病特征、生活质量（PDQ-39）、抑郁和焦虑（HADS-D、HADS-A）之间的关联。总体而言，疼痛的患病率很高（95.4%）；91.1%的患者患有慢性疼痛，但只有 22.3%的患者被诊断为疼痛障碍。疼痛中度至非常严重地影响了 48.4%的患者的日常生活，并且在所有患者中，疼痛是最困扰的症状，占 10.2%。疼痛主要位于背部（71.4%）或关节（52.4%），常发生为疼痛发作（79%），但只有 15.3%的患者出现神经病理性特征。大多数患者（74.2%）接受了某种形式的疼痛治疗，主要由矫形医生（62.0%）或全科医生（50.0%）提供。物理治疗（61.3%）、止痛药（54.4%）或按摩（35.5%）是最常见的治疗措施。康复治疗（96.3%）和物理治疗（89.5%）被评为最有效，但效果短暂。53.3%的患者认为 PD 是其疼痛的主要原因，但只有 33.6%的患者从抗帕金森病药物中得到缓解。疼痛程度较高与抑郁和焦虑程度较高以及生活质量较低有关。研究结果表明，PD 患者的疼痛较为常见、复杂，且会降低生活质量，但疼痛的诊断和治疗不足，需要系统地研究基于病理生理学的治疗策略。
