Al-Sagheer Majd, Karttunen Niina, Paakinaho Anne, Koponen Marjaana, Kaasinen Valtteri, Hartikainen Sirpa, Tiihonen Miia, Tolppanen Anna-Maija
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
Eur J Pain. 2025 Jul;29(6):e70056. doi: 10.1002/ejp.70056.
Pain is a common symptom of Parkinson's disease (PD). It occurs also as a prodromal sign of PD. It has not yet been described how the use of analgesics changes over time in persons with PD. We investigated the incidence of opioid use from 5 years before to 5 years after PD diagnosis and compared the incidence to a matched cohort.
This study included 15,763 people diagnosed with incident PD in 2001-2014 and 62,907 matched comparison persons without PD from the Finnish nationwide register-based study on Parkinson's disease (FINPARK). Initiation rates of opioid use during the follow-up were calculated in 6-month time windows, and the difference between persons with and without PD was described using incidence rate ratios (IRRs).
Opioid initiation was more common among persons with PD (37.0%) compared to people without PD (31.2%). The difference between the groups emerged 3 years before the PD diagnosis IRR 1.33 (1.16-1.53), and remained until the end of the follow-up. Mild opioids, such as tramadol and codeine, were the most commonly initiated opioids, and the largest difference in their use was observed 6 months prior to the diagnosis date, while differences in strong opioids emerged after the PD diagnosis. Initiation rates increased over time and remained above those of the comparison group after the PD diagnosis for all opioid classes.
The findings demonstrate the incidence of moderate/severe pain in PD, which requires treatment with opioid-class analgesics. Further studies are needed to understand the long-term impact of opioid use in persons with PD.
Initiation rate of opioids is increased in persons with Parkinson's disease already at premotor or early motor stage, before the diagnosis is confirmed. Shift towards stronger opioids is observed over the disease progress. Further studies are needed to investigate optimized pain management strategies in Parkinson's disease.
疼痛是帕金森病（PD）的常见症状，它也作为PD的前驱症状出现。目前尚未描述PD患者使用镇痛药的情况随时间如何变化。我们调查了PD诊断前5年至诊断后5年阿片类药物的使用发生率，并将该发生率与匹配队列进行比较。
本研究纳入了2001年至2014年确诊为新发PD的15763人，以及来自芬兰全国基于登记的帕金森病研究（FINPARK）的62907名匹配的无PD对照者。在6个月的时间窗内计算随访期间阿片类药物的起始使用率，并使用发病率比（IRR）描述PD患者和非PD患者之间的差异。
与无PD的人（31.2%）相比，PD患者中阿片类药物起始使用更为常见（37.0%）。两组之间的差异在PD诊断前3年出现，IRR为1.33（1.16 - 1.53），并一直持续到随访结束。轻度阿片类药物，如曲马多和可待因，是最常起始使用的阿片类药物，在诊断日期前6个月观察到它们使用的最大差异，而强阿片类药物的差异在PD诊断后出现。所有阿片类药物的起始使用率随时间增加，且在PD诊断后仍高于对照组。
研究结果表明PD中存在中度/重度疼痛的发生率，这需要用阿片类镇痛药进行治疗。需要进一步研究以了解阿片类药物在PD患者中的长期影响。
在帕金森病患者中，在运动前或运动早期、确诊之前，阿片类药物的起始使用率就已增加。在疾病进展过程中观察到向更强效阿片类药物的转变。需要进一步研究以调查帕金森病中优化的疼痛管理策略。
