Quantitative measurement of pain sensation in patients with Parkinson disease
Quantitative measurement of pain sensation in patients with Parkinson disease
复制标题
DOI：
10.1212/01.wnl.0000130455.38550.9d
复制
发表时间：
2004-06-22
期刊：
影响因子：
9.9
通讯作者：
Yarnitsky, D
中科院分区：
文献类型：
--
作者：
Djaldetti, R;Shifrin, A;Yarnitsky, D
背景：疼痛在帕金森病（PD）患者中很常见，并且可以先于疾病的诊断。实验研究和临床证据表明基底神经节和多巴胺能通路参与中枢疼痛处理。目的：定量评估和比较单侧PD伴和不伴疼痛患者以及反应波动患者的疼痛感知。研究方法：36例主要为单侧疾病的PD患者（平均年龄61.8 ± 11.2岁）、15例缓解波动患者（平均年龄65.3 ± 10.4岁）和28例年龄匹配的健康对照受试者参加了研究。使用视觉模拟量表评估主观疼痛，其中von Frey细丝用于触觉阈值，接触热电极用于温热感（WS）和热痛阈值（HPT）。结果：触觉和WS阈值在两个患者组和对照组之间没有差异，也没有两侧之间的差异。有疼痛的PD患者（n = 21）的HPT低于无疼痛的PD患者（42.6 +/- 3.0 ℃ vs 45.6 +/- 2.8 ℃; p < 0.01）和那些在更受影响的一侧经历疼痛的人（41.4 +/- 2.6 ℃ vs 43.7 +/- 3.3 ℃; p < 0.0001）。在波动的患者中，WS和HPT或“开”期和“关”期之间无侧差异。结论：帕金森病患者的内源性疼痛伴随着对某些疼痛刺激的敏感性增加，这表明基底神经节异常也涉及疼痛编码。
Background: Pain is common in patients with Parkinson disease (PD) and can precede the diagnosis of the disease. Experimental studies and clinical evidence indicate involvement of basal ganglia and dopaminergic pathways in central pain processing. Objective: To quantitatively assess and compare pain perception in patients with unilateral PD with and without pain and in patients with response fluctuations. Methods: Thirty-six patients with PD ( mean age, 61.8 +/- 11.2 years) with predominantly unilateral disease, 15 patients with response fluctuations ( mean age, 65.3 +/- 10.4 years), and 28 age-matched healthy control subjects participated in the study. Subjective pain was assessed using the visual analog scale with von Frey filaments for tactile thresholds and contact thermode for warm sensation (WS) and heat pain thresholds (HPTs). Results: Tactile and WS thresholds did not differ between patients in both patient groups and control subjects nor between sides. HPT was lower in patients with PD who experienced pain ( n = 21) compared with those who did not ( 42.6 +/- 3.0 degreesC vs 45.6 +/- 2.8 degreesC; p < 0.01) and those who experienced pain in the more affected side (41.4 +/- 2.6 degrees C vs 43.7 +/- 3.3 degrees C; p < 0.0001). In patients with fluctuations there were no side differences in WS and HPT or between "on" and "off" periods. Conclusion: Endogenous pain in patients with Parkinson disease is accompanied by increased sensitivity to some painful stimuli, suggesting that basal ganglia abnormality also involves pain encoding.