Pain in Extrapyramidal Neurodegenerative Diseases
Pain in Extrapyramidal Neurodegenerative Diseases
复制标题
锥体外系神经退行性疾病的疼痛
DOI：
10.1097/ajp.0000000000000437
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
R. Djaldetti
中科院分区：
文献类型：
--
作者：
S. Yust;R. Hershkovitz;T. Gurevich;R. Djaldetti
目的：疼痛是帕金森病（PD）和其他帕金森综合征最常见的非运动症状之一，对生活质量有重要影响。该研究的目的是研究帕金森病和其他帕金森综合征患者疼痛的患病率和特征，以及患者对止痛药的使用和反应。方法：该队列包括371例患者：PD患者300例（81%），帕金森+综合征患者71例（19%）。通过问卷调查收集临床参数和疼痛数据。用统一PD评定量表对PD患者进行疾病严重程度的测量。结果：277例（74%）患者报告了疼痛，其中PD患者241例，帕金森+综合征患者36例。PD患者的疼痛发生率明显高于帕金森+综合征患者（80%比50%，P<0.001），突触核蛋白病患者的疼痛发生率明显高于tau病患者（70%比40%，P<0.001）。在突触核蛋白病中，最常见的疼痛是中枢性疼痛（32%），而在牛头病中，只有4%的患者有中枢性疼痛。抗帕金森治疗减轻了21% PD患者的疼痛。只有114名（48%）有疼痛经历的患者接受了止痛药治疗。最有益的镇痛药是非甾体抗炎药和医用大麻。结论：疼痛在PD和帕金森综合征患者中普遍存在。可以通过更密集的抗帕金森药物或止痛药来缓解疼痛。
Objective: Pain is one of the most common nonmotor symptoms of Parkinson disease (PD) and other Parkinson plus syndromes, with a major effect on quality of life. The aims of the study were to examine the prevalence and characteristics of pain in PD and other Parkinson plus syndromes and patient use and response to pain medications. Methods: The cohort consisted of 371 patients: 300 (81%) with PD and 71 (19%) with Parkinson plus syndromes. Data on clinical parameters and pain were collected by questionnaire. Disease severity was measured with the Unified PD Rating Scale for patients with PD. Results: Pain was reported by 277 patients (74%): 241 with PD and 36 with Parkinson plus syndromes. The prevalence of pain was significantly higher in the patients with PD than in the patients with Parkinson plus syndromes (80% vs. 50%, P<0.001) and higher in patients with synucleinopathies than in patients with tauopathies (70% vs. 40%, P<0.001). In the synucleinopathies, the most common pain was central pain (32%), whereas in the tauopathies only 4% of patients had central pain. Anti-Parkinson treatment relieved the pain in 21% of the patients with PD. Only 114 patients (48%) who experienced pain were treated with pain medications. The most beneficial analgesics were nonsteroidal anti-inflammatory drugs and medical cannabis. Conclusion: Pain is prevalent among patients with PD and Parkinsonian plus syndromes. Pain relief can be achieved by more intensive anti-Parkinson medications or pain medications.