Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Mov Disord. 2020 Dec;35(12):2338-2343. doi: 10.1002/mds.28241. Epub 2020 Sep 18.
Of patients with Parkinson's disease (PD), 30% to 85% report pain. However, mechanisms underlying this pain remain unclear. In line with known neuroanatomical impairments, we hypothesized that pain in PD is caused by alterations in emotional-motivational as opposed to sensory-discriminative pain processing and that dopamine recovers the capacity for endogenous emotional-motivational pain modulation in patients with PD.
A total of 20 patients with PD played a random reward paradigm with painful heat stimuli in addition to assessments of pain sensitivity once with and once without levodopa.
Levodopa increased endogenous pain inhibition in terms of perceived pain intensity and un/pleasantness compared with a medication off state. Higher clinical pain was associated with higher increases in pain inhibition. Levodopa did not affect heat pain threshold, tolerance, or temporal summation.
Patients with PD seem to be predominately impaired in emotional-motivational as opposed to sensory-discriminative pain processing. A differential understanding of pain in PD is urgently needed because effective treatment strategies are lacking. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
30%至 85%的帕金森病（PD）患者报告有疼痛。然而，这种疼痛的机制仍不清楚。根据已知的神经解剖学损伤，我们假设 PD 中的疼痛是由情感动机性疼痛处理而不是感觉辨别性疼痛处理的改变引起的，并且多巴胺恢复了 PD 患者内源性情感动机性疼痛调节的能力。
共有 20 名 PD 患者在接受痛觉刺激的随机奖励范式中进行了测试，此外还在服用左旋多巴和不服用左旋多巴时各进行了一次疼痛敏感性评估。
与停药状态相比，左旋多巴增加了感知疼痛强度和不/愉快感方面的内源性疼痛抑制。较高的临床疼痛与疼痛抑制的增加呈正相关。左旋多巴不影响热痛阈值、耐受度或时间总和。
PD 患者似乎主要在情感动机性疼痛处理方面受损，而不是在感觉辨别性疼痛处理方面受损。由于缺乏有效的治疗策略，迫切需要对 PD 中的疼痛有一个不同的理解。2020 年，作者。运动障碍由 Wiley Periodicals LLC 代表国际帕金森病和运动障碍协会出版。
