Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust.
Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
Curr Opin Neurol. 2019 Aug;32(4):579-588. doi: 10.1097/WCO.0000000000000711.
In this review, we discuss the most recent evidence on mechanisms underlying pathological nociceptive processing in Parkinson's disease patients, as well as novel treatment strategies.
In Parkinson's disease, specific neurodegenerative changes may cause alterations in nociceptive processing at multiple levels. Optimization of dopaminergic therapies should always be the first step in the management of Parkinson's disease pain. Reportedly, rotigotine transdermal patch, a monoamine oxidase type B inhibitor safinamide (as an add-on therapy to levodopa), subcutaneous apomorphine and intrajejunal levodopa infusion therapy may have a beneficial effect on pain sensations in Parkinson's disease patients. Among the nondopaminergic pharmacological therapies, prolonged-release oxycodone/naloxone and duloxetine may be effective in the treatment of chronic pain in Parkinson's disease. Botulinum toxin (BTX) injections should be considered for the treatment of dystonic Parkinson's disease pain. Deep brain stimulation (DBS) may lead to pain relief with a long-lasting effect in Parkinson's disease patients. Physiotherapy and physical activity in general are essential for Parkinson's disease patients suffering from pain.
Pain in Parkinson's disease is not simply a consequence of motor complainants. The management of Parkinson's disease-related pain implicates maintenance of stable levels of dopaminergic drugs. Nondopaminergic pharmacological therapies (prolonged-release oxycodone/naloxone, duloxetine, BTX) and nonpharmacological interventions (DBS, physiotherapie) may also be beneficial in treatment of Parkinson's disease pain.
在这篇综述中,我们讨论了帕金森病患者病理性疼痛处理机制的最新证据,以及新的治疗策略。
在帕金森病中,特定的神经退行性变化可能导致多个水平的疼痛处理改变。优化多巴胺能治疗应该始终是帕金森病疼痛管理的第一步。据报道,罗替高汀透皮贴剂、单胺氧化酶 B 抑制剂沙芬酰胺(作为左旋多巴的附加疗法)、皮下阿扑吗啡和空肠内左旋多巴输注疗法可能对帕金森病患者的疼痛感觉有有益的影响。在非多巴胺能药物治疗中,缓释羟考酮/纳洛酮和度洛西汀可能对帕金森病慢性疼痛有效。肉毒杆菌毒素(BTX)注射应考虑用于治疗帕金森病的肌张力障碍性疼痛。深部脑刺激(DBS)可能导致帕金森病患者疼痛缓解并具有持久效果。一般来说,物理治疗和体育活动对患有疼痛的帕金森病患者至关重要。
帕金森病的疼痛不仅仅是运动抱怨的结果。帕金森病相关疼痛的管理需要维持稳定的多巴胺能药物水平。非多巴胺能药物治疗(缓释羟考酮/纳洛酮、度洛西汀、BTX)和非药物干预(DBS、物理治疗)也可能对帕金森病疼痛的治疗有益。