上海地区帕金森病患者慢性疼痛及其有关影响因素的临床研究

Clinical Study on Chronic Pain in Parkinson's Disease Patients in Shanghai

目的评估上海地区原发性帕金森病(PD)患者中与PD相关疼痛症状的患病率及流行病学特征。方法对上海市12个综合性医院共1 058例诊断明确的原发性PD患者进行结构问卷调查。包括运动障碍的严重程度、抗PD治疗、疼痛相关数据(疼痛发作时间点、持续时间、程度、部位、其他症状、治疗情况)等资料进行收集与分析。结果 1 058例PD患者中1 096例完成调查,约有28.8%(296例)有PD相关性疼痛症状。在PD早期阶段,与男性PD疼痛患者比较女性具有发病率高(P<0.05)、年龄层级高(P<0.05)、发病年龄高(P<0.05)、疼痛频率高(P<0.05)、疼痛先于运动障碍症状出现的频率高(P<0.05)和疼痛持续时间较长(P<0.05)的特点。PD合并疼痛患者就无合并疼痛患者而言,具有较大的左旋多巴等效剂量(P<0.05)、睡眠障碍(P<0.05)和(或)运动障碍的高发生率(P<0.05)。最常见的疼痛类型是骨骼肌疼痛,其次是肌张力障碍疼痛;男性患者疼痛持续时间较女性患者短;疼痛多在服用抗PD药物后出现。结论慢性PD相关性疼痛是常见且复杂的并发症,发病机制复杂;PD慢性疼痛的综合治疗是富有挑战的课题,最终会找到有效的治疗策略。

Aim To assess the prevalence and identify the epidemiological characteristics of Parkinson’s disease （PD） related pain among the patients with idiopathic PD in Shanghai, the pain with Parkinson’s disease （PD） may be more distressing than that with other non-motor disabilities. Methods A total of 1058 patients with deifnite idiopathic PD in 12 hospitals in Shanghai were investigated using a structure questionnaire. The severity of their motor disorders, anti-parkinsonism treatments, and pain related observations, such as time points for onset of pain, duration and degree, body localization, external inlfuences, and treatments for pain, were collected for analysis. Results Approximate 28.4%（296 subjects） of the PD patients suffered from PD related pain. Female patients with pain had a higher age level （P﹤0.05）, higher PD onset age （P﹤0.05）, higher frequency of pain （P﹤0.05）, higher frequency with pain before PD symptoms （P﹤0.05）, longer duration of pain （P﹤0.05）, and higher incidence of pain in the early stage （P﹤0.05） compared with the male patients. Larger levodopa equivalent doses （P﹤0.05）, higher frequencies of sleep disorder （P﹤0.05） and/or motor fluctuation （P﹤0.05）, and/or dyskinesia （P﹤0.05） were found in pain patients compared with no pain patients. The most frequent pain type was musculoskeletal followed by dystonia. The male group had much shorter pain duration than the female group. More pain appeared after taking anti-parkinsonism drugs. Conclusion Chronic PD-related pain is a frequent complaint with complex pathogenesis in PD. The challenge of managing pain in PD patients will someday result in speciifc and effective treatment strategies.