帕金森病伴疼痛的临床特点及相关因素

The prevalence,characteristics,and risk factors of pain in patients with Parkinson’s disease

目的 探讨帕金森病伴发疼痛的特点及相关影响因素。方法将128例原发性帕金森病患者分为疼痛组和非疼痛组,使用统一帕金森病评分量表、Hoehn-Yahr(H-Y)分期、汉密顿抑郁量表(HRSD)、视觉模拟评分法(VAS)、蒙特利尔认知评估量表(MoCA)等进行评估。结果128例患者中,63例(49.2%)伴有疼痛,VAS评分为(3.93±2.81)分。63例中慢性起病52例(82.5%),急性起病11例(17.5%);骨骼肌肉痛48例(76.2%),神经根性痛15例(23.8%),中枢性疼痛8例(12.7%),肌张力障碍性疼痛6例(9.5%),静坐不能5例(7.9%);患者诉有1种形式疼痛42例(66.7%),2种形式疼痛17例(27.0%),3种形式疼痛4例(6.3%)。患者未接受疼痛治疗42例(66.7%),仅接受过药物治疗4例(6.3%),仅接受过物理治疗13例(20.6%),同时接受过药物和物理治疗4例(6.3%)。疼痛组患者UPDRSⅠ-Ⅳ各项得分、H-Y分期及HRSD得分均高于非疼痛组(均P<0.05)。logistic回归分析显示HRSD得分是帕金森病患者伴发疼痛的危险因素(OR=1.095,95%CI:1.028~1.202,P=0.006)。结论PD患者伴发疼痛发生率高,临床表现多样,抑郁可能是其危险因素。

Objective To investigate the prevalence,characteristics,and risk factors of pain in patients with Parkinson’s disease(PD).Methods A totaI of 128 PD patients were enrolled in the study and assessed with the following rating scales:Unified Parkinson’s Disease Rating Scale(UPDRS),Hoehn-Yahr Scale(H-Y),Hamilton Depression Rating Scale for Depression(HRSD),Visual Analogue Scale(VAS)and Montreal Cognitive Assessment(MoCA).Results There were 63 cases(49.2%)of PD patients who repoted pain,and their average mean VAS score was 3.93±2.81.The pain symptous of 52 cases(82.5%)occarred ohronically,and 11 cases(17.5%)accurred acutely.76.2%of the PD patients with pain were presented with musculoskeletal pain,23.8%with radicular-neuropathic pain,12.7%with central neuropathic pain,9.5%with dystonic pain,and 7.9%with akathisia pain.Further more,only 42 of the PD patients with pain received pain related treatment.Compared with PD patients without pain,PD patients with pain had higher scores of UPDRS,H-Y and HRSD scores.Depression(scores of HRSD)was the only factor associated with pain showed by the logistic regression model(P=0.006).Conclusions The frequency of pain in PD patients is high,the clinical manifestation is diverse,and depression is a predictor of pain in PD patients.