Pain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy
Pain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy
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DOI：
10.1007/s00415-017-8426-y
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发表时间：
2017-04-01
影响因子：
6
通讯作者：
Bingel, Ulrike
中科院分区：
文献类型：
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作者：
Buhmann, Carsten;Wrobel, Nathalie;Bingel, Ulrike
我们的目的是评估帕金森病（PD）患者疼痛的患病率、表型和治疗现实。因此，我们采用德国疼痛量表（DSF）、PainDetect和自行开发的帕金森病疼痛量表（PainPQ）对181例PD门诊患者进行了横断面评估，涵盖了详细的治疗方面。此外，我们还调查了疼痛与PD疾病特征、生活质量（PDQ-39）、抑郁和焦虑（HADS-D、HADS-A）之间的关系。总体而言，疼痛的患病率很高（95.4%）; 91.1%患有慢性疼痛，但其中只有22.3%被诊断为疼痛障碍。疼痛在48.4%的患者中中度至非常严重地损害日常生活，并且是所有患者中10.2%的最令人痛苦的症状。疼痛主要发生在背部（71.4%）或关节（52.4%），常以疼痛发作（79%）出现，但仅15.3%的患者出现神经病理性疼痛。大多数患者（74.2%）接受了某种疼痛治疗，主要由骨科医生（62.0%）或全科医生（50.0%）提供。物理治疗（61.3%）、止痛药（54.4%）或按摩（35.5%）是最常见的治疗措施。康复治疗（96.3%）和物理治疗（89.5%）被认为是最有效的，但有很大的暂时性影响。53.3%的患者认为PD是他们疼痛的主要原因，但只有33.6%的患者发现抗帕金森病药物缓解。高水平的疼痛与较高的抑郁和焦虑评分以及较低的生活质量相关。结果表明，疼痛PD是频繁的，复杂的，和生活质量的损害，但诊断不足和非系统性治疗，并表明需要系统地研究基于病理生理学的治疗策略。
We aimed to evaluate prevalence, phenotype, and therapeutic realities of pain in patients with Parkinson disease (PD). Therefore, we assessed 181 outpatients with PD using a cross-sectional approach applying the German Pain Questionaire (DSF), the PainDetect, and a self-developed Parkinson Disease Pain Questionaire (UPDPQ) covering detailed therapeutic aspects. Furthermore, we investigated the association between pain and PD-disease characteristics, quality of life (PDQ-39), depression, and anxiety (HADS-D, HADS-A). Overall, prevalence of pain was high (95.4%); 91.1% suffered from chronic pain, but in only 22.3% of them, pain disorder was diagnosed. Pain impaired everyday-life moderately to very severely in 48.4% of patients and was the most distressing symptom in 10.2% of all patients. Pain was localized mainly in the back (71.4%) or joints (52.4%), frequently occurred as pain attacks (79%) but appeared with neuropathic character in only 15.3% of patients. Most patients (74.2%) received some kind of pain treatment, mainly provided by orthopedists (62.0%) or general practitioners (50.0%). Physiotherapy (61.3%), pain killers (54.4%), or massage (35.5%) were the most frequent therapeutic measures. Rehabilitative therapy (96.3%) and physiotherapy (89.5%) were rated as most effective, but with vastly temporary effects. 53.3% of patients attributed PD as the main cause for their pain, but only 33.6% found relief from anti-parkinsonian drugs. High levels of pain were associated with higher scores of depression and anxiety, and lower quality of life. Results suggest that pain in PD is frequent, complex, and quality-of-life-impairing but under-diagnosed and unsystematically treated and indicate need to systematically investigate pathophysiology-based treatment strategies.