1Department of Neurosurgery, University of South Florida, Tampa, Florida.
2Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Neurosurg. 2022 Apr 29;137(6):1821-1830. doi: 10.3171/2022.2.JNS212561. Print 2022 Dec 1.
Pain is the most common nonmotor symptom of Parkinson's disease (PD) and is often undertreated. Deep brain stimulation (DBS) effectively mitigates the motor symptoms of this multisystem neurodegenerative disease; however, its therapeutic effect on nonmotor symptoms, especially pain, remains inconclusive. While there is a critical need to help this large PD patient population, guidelines for managing this significant disease burden are absent. Herein, the authors systematically reviewed the literature and conducted a meta-analysis to study the influence of traditional (subthalamic nucleus [STN] and globus pallidus internus [GPi]) DBS on chronic pain in patients with PD.
The authors performed a systematic review of the literature and a meta-analysis following PRISMA guidelines. Risk of bias was assessed using the levels of evidence established by the Oxford Centre for Evidence-Based Medicine. Inclusion criteria were articles written in English, published in a peer-reviewed scholarly journal, and about studies conducting an intervention for PD-related pain in no fewer than 5 subjects.
Twenty-six studies were identified and included in this meta-analysis. Significant interstudy heterogeneity was detected (Cochran's Q test p < 0.05), supporting the use of the random-effects model. The random-effects model estimated the effect size of DBS for the treatment of idiopathic pain as 1.31 (95% CI 0.84-1.79). The DBS-on intervention improved pain scores by 40% as compared to the control state (preoperative baseline or DBS off).
The results indicated that traditional STN and GPi DBS can have a favorable impact on pain control and improve pain scores by 40% from baseline in PD patients experiencing chronic pain. Further trials are needed to identify the subtype of PD patients whose pain benefits from DBS and to identify the mechanisms by which DBS improves pain in PD patients.
疼痛是帕金森病（PD）最常见的非运动症状，且常治疗不足。深部脑刺激（DBS）可有效缓解这种多系统神经退行性疾病的运动症状；然而，其对非运动症状，尤其是疼痛的治疗效果仍不确定。虽然迫切需要帮助这一大 PD 患者群体，但缺乏管理这一重大疾病负担的指南。在此，作者系统地回顾了文献并进行了荟萃分析，以研究传统（丘脑底核 [STN] 和苍白球内部 [GPi]）DBS 对 PD 患者慢性疼痛的影响。
作者按照 PRISMA 指南对文献进行了系统回顾和荟萃分析。使用牛津循证医学中心确立的证据水平评估偏倚风险。纳入标准为以英文撰写、发表在同行评议学术期刊上、对不少于 5 例 PD 相关疼痛进行干预的研究。
确定了 26 项研究并纳入本荟萃分析。检测到显著的研究间异质性（Cochran's Q 检验，p < 0.05），支持使用随机效应模型。随机效应模型估计 DBS 治疗特发性疼痛的效果大小为 1.31（95%CI 0.84-1.79）。与对照状态（术前基线或 DBS 关闭）相比，DBS-on 干预可使疼痛评分提高 40%。
结果表明，传统的 STN 和 GPi DBS 可对疼痛控制产生有利影响，并可使 PD 慢性疼痛患者的疼痛评分从基线提高 40%。需要进一步的试验来确定哪些 PD 患者的疼痛从 DBS 中获益，以及确定 DBS 改善 PD 患者疼痛的机制。
