Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, United Kingdom.
Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, United Kingdom.
Parkinsonism Relat Disord. 2018 Nov;56:27-32. doi: 10.1016/j.parkreldis.2018.06.001. Epub 2018 Jun 6.
The causes of pain in early/moderate Parkinson's disease (PD) are not well understood. Although peripheral factors such as rigidity, reduced joint movements and poor posture may contribute towards the development of pain, central mechanisms including altered nociceptive processing may also be involved.
We performed a large clinical study to investigate potential factors contributing towards pain in early/moderate PD. We recruited 1957 PD participants who had detailed assessments of pain, motor and non-motor symptoms. The King's Parkinson's Pain scale was used to quantify different subtypes of pain.
85% of participants reported pain (42% with moderate to severe pain). Pain influenced quality of life more than motor symptoms in a multiple regression model. Factors predicting overall pain severity included affective symptoms, autonomic symptoms, motor complications, female gender and younger age, but not motor impairment or disease duration. There was negligible correlation between the severity of motor impairment and the severity of musculoskeletal or dystonic pain as well as between the severity of OFF period motor problems and the severity of OFF period pain or OFF period dystonic pain. Features of central sensitization, including allodynia and altered pain sensation were common in this population. The use of drugs targeting central pain was very low.
Pain in early/moderate PD cannot be explained by peripheral factors. Central causes may play a much more important role than previously considered. These results should lead to a major shift in the investigation and management of this common and disabling symptom.
早期/中度帕金森病（PD）疼痛的原因尚不清楚。虽然僵硬、关节运动减少和姿势不良等外周因素可能导致疼痛的发展，但包括感觉异常处理改变在内的中枢机制也可能涉及其中。
我们进行了一项大型临床研究，以调查导致早期/中度 PD 疼痛的潜在因素。我们招募了 1957 名 PD 参与者，对他们的疼痛、运动和非运动症状进行了详细评估。使用 King's Parkinson's Pain 量表来量化不同类型的疼痛。
85%的参与者报告有疼痛（42%有中重度疼痛）。在多元回归模型中，疼痛对生活质量的影响大于运动症状。预测总体疼痛严重程度的因素包括情感症状、自主神经症状、运动并发症、女性性别和年龄较小，但与运动障碍或疾病持续时间无关。运动障碍严重程度与肌肉骨骼或张力性疼痛严重程度之间，以及 OFF 期运动问题严重程度与 OFF 期疼痛或 OFF 期张力性疼痛严重程度之间几乎没有相关性。该人群中常见的中枢敏化特征，包括感觉过敏和疼痛感觉改变。针对中枢性疼痛的药物的使用非常低。
早期/中度 PD 中的疼痛不能用外周因素来解释。中枢原因可能比以前认为的更为重要。这些结果应该导致对这种常见且致残症状的调查和管理发生重大转变。
