Department of Neurology, University of Rostock, Rostock, Germany.
German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany.
J Parkinsons Dis. 2024;14(7):1451-1468. doi: 10.3233/JPD-240026.
Pain fluctuations are a characteristic phenomenon in advanced Parkinson's disease (PD), but their temporal association with motor and non-motor symptom (NMS) fluctuations remains largely enigmatic. Moreover, data on their importance for disease severity perception and health-related quality-of-life (hr-QoL) is limited.
To dissect pain fluctuations with respect to pain type and frequency patterns, and their association with motor and non-motor fluctuations.
Prospective observational cohort study in advanced PD assessing symptom fluctuations by simultaneous hourly ratings using the PD Home diary (Off, On, Dyskinetic state), a pain diary (assessing 9 pain types) and a non-motor diary (10 key NMS) based on validated instruments.
Forty-seven out of 55 eligible participants with fluctuating PD (51% men, median age 65, median disease duration 10 years) had sufficient datasets (>95% of hours) from 2 consecutive days. Pain was reported in 35% of waking hours with clear circadian rhythm peaking in early morning Off periods and clustering during motor Off state (49% of Off state hours with pain). Main NMS co-fluctuating with pain were "Fatigue" and "Inner Restlessness". Simultaneous assessment of global disease severity by participants revealed that pain was associated with worse disease severity only in motor On and Dyskinetic state but not in Off state, which translated into significant correlations of daily pain times with hr-QoL only during motor On and Dyskinetic state.
Aside from treating motor Off periods, specific recognition of pain particularly during motor On and Dyskinetic state comprises an important aspect for disease management in advanced PD.
疼痛波动是晚期帕金森病（PD）的一个特征性现象，但它们与运动和非运动症状（NMS）波动的时间关联在很大程度上仍是个谜。此外，关于它们对疾病严重程度感知和健康相关生活质量（hr-QoL）的重要性的数据也很有限。
剖析疼痛波动与疼痛类型和频率模式的关系，以及它们与运动和非运动波动的关联。
一项前瞻性观察性队列研究，在晚期 PD 中使用 PD 家庭日记（Off、On、运动障碍状态）、疼痛日记（评估 9 种疼痛类型）和基于验证工具的非运动日记（10 个关键 NMS）进行同步每小时评估，以评估症状波动。
在符合条件的 55 名有波动 PD 的患者中，有 47 名（51%为男性，中位年龄 65 岁，中位病程 10 年）有足够的连续 2 天数据集（>95%的小时）。清醒时疼痛报告发生率为 35%，具有明显的昼夜节律，在 Off 期的清晨达到高峰，并在运动 Off 期聚集（49%的 Off 期小时有疼痛）。与疼痛同时出现的主要 NMS 为“疲劳”和“内在不安”。参与者同时评估整体疾病严重程度，结果显示疼痛仅与运动 On 和运动障碍期的疾病严重程度相关，而与 Off 期无关，这转化为每日疼痛时间与 hr-QoL 仅在运动 On 和运动障碍期显著相关。
除了治疗运动 Off 期外，特别在运动 On 和运动障碍期识别疼痛是晚期 PD 疾病管理的一个重要方面。
