Department of Neurology, Canisius Wilhelmina Hospital Nijmegen, Nijmegen, The Netherlands; Neuromuscular Center Nijmegen, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.
Neuromuscular Center Nijmegen, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.
J Pain. 2018 Aug;19(8):920-930. doi: 10.1016/j.jpain.2018.03.006. Epub 2018 Mar 27.
Pain is a common but often ignored symptom in patients with myotonic dystrophy type 2 (DM2). In this explorative study, we assessed qualitative and quantitative aspects of pain in DM2 using 4 questionnaires and quantitative sensory testing. A disease control group (fibromyalgia [FMS]) as well as healthy controls were used to compare the results, because pain in DM2 shows many clinical similarities to pain in FMS. Thirty-four patients with genetically confirmed DM2 (71% female, mean age 54 years), 28 patients with FMS, and 33 healthy controls were included, age- as well as sex-matched. Pain prevalence was 65% in DM2, 100% in FMS (P < .001), and 15% in healthy controls (P < .001). The mean of the pressure pain thresholds was lower in DM2 than in healthy controls (P = .016), with the largest differences in the rectus femoris, trapezius, and thenar muscles. Mechanical and electric pain thresholds were significantly higher in DM2 than in FMS, and no differences were found in electric pain thresholds between DM2 and healthy controls. These results confirm that pain is a frequent and important symptom in patients with DM2, affecting quality of life. Peripheral mechanisms of pain seem to play a role in DM2. The widespreadness of the hyperalgesia suggests central sensitization, but this finding was not supported by the other results. This study opens new avenues for further research and eventually novel treatment strategies, in DM2 as well as in other muscular disorders.
This article presents qualitative as well as quantitative aspects of pain in patients with DM2. Pain is a frequent and important symptom in patients with DM2, affecting quality of life. We found mechanical hyperalgesia, indicative of a peripheral mechanism of pain. The widespreadness of hyperalgesia may suggest central sensitization, but this finding was not supported by other results and needs further exploration.
肌强直性营养不良 2 型（DM2）患者常伴有疼痛，但通常被忽视。本研究通过 4 种问卷和定量感觉测试评估 DM2 患者疼痛的定性和定量方面，并与纤维肌痛（FMS）疾病对照组和健康对照组进行比较，因为 DM2 中的疼痛与 FMS 中的疼痛具有许多临床相似性。
本研究纳入 34 名经基因确诊的 DM2 患者（71%为女性，平均年龄 54 岁）、28 名 FMS 患者和 33 名健康对照者，对其进行年龄和性别匹配。
DM2 患者的疼痛发生率为 65%，FMS 患者为 100%（P<0.001），健康对照组为 15%（P<0.001）。DM2 患者的压力疼痛阈值均值低于健康对照组（P=0.016），差异最大的部位在股直肌、斜方肌和大鱼际。DM2 患者的机械和电痛阈值均显著高于 FMS 患者，且 DM2 患者与健康对照组的电痛阈值无差异。
这些结果证实疼痛是 DM2 患者的常见且重要的症状，影响生活质量。疼痛的外周机制可能在 DM2 中起作用。痛觉过敏的广泛性提示存在中枢敏化，但这一发现并未得到其他结果的支持。本研究为进一步研究提供了新的途径，并最终为 DM2 以及其他肌肉疾病提供了新的治疗策略。
本文介绍了 DM2 患者疼痛的定性和定量方面。疼痛是 DM2 患者的常见且重要的症状，影响生活质量。我们发现机械性痛觉过敏，表明存在疼痛的外周机制。痛觉过敏的广泛性可能提示存在中枢敏化，但这一发现并未得到其他结果的支持，需要进一步探索。
