柔筋止痛针刺法治疗帕金森病伴发不同类型疼痛患者的临床观察

Treatment of Different Types of Pain in Parkinson′s Disease by Tendon-softening and Pain-relieving Acupuncture

目的观察柔筋止痛针刺法治疗帕金森病伴发疼痛的疗效及对不同类型疼痛的治疗效果。方法将帕金森病伴发疼痛患者84例,根据Chandhur疼痛分类形式分为骨骼肌疼痛(22例)、根性疼痛(10例)、运动障碍性疼痛(34例)、不能静坐或坐立不安感导致的疼痛(14例)及其他(4例)。所有患者常规口服治疗帕金森病西药,停止服用止痛类药物,同时给予柔筋止痛针刺法治疗,采用平补平泻法,留针30min,每日1次。5次为1个疗程,共治疗2个疗程。治疗前后对不同类型疼痛患者进行中医证候评分、疼痛视觉模拟量表(VAS)评分、国王帕金森病疼痛评价量表(KPPS)评分、帕金森综合评分量表(UPDRS)评分,治疗后对84例患者评价中医证候疗效。结果84例患者中临床痊愈0例,明显进步21例,进步48例,稍有进步5例,无效10例,总有效74例,总有效率为88.1%;与治疗前比较,治疗后患者中医证候总积分、VAS评分、KPPS评分中疼痛频次和总积分、UPDRS评分均降低(P<0.05或P<0.01)。由于其他类型疼痛患者病例数较少不纳入统计分析。治疗后,帕金森病骨骼肌疼痛患者中医证候总积分、VAS评分、KPPS评分总积分及UPDRS评分均较治疗前降低(P<0.05或P<0.01);帕金森病静坐不能或坐立不安感导致的疼痛患者VAS评分、KPPS评分总积分及疼痛频次较治疗前降低(P<0.05或P<0.01),而UPDRS评分差异无统计学意义(P>0.05)。帕金森病根性疼痛、运动障碍性疼痛患者VAS评分、KPPS评分、UPDRS评分较治疗前比较差异均无统计学意义(P>0.05),但中医证候总积分差异有统计学意义(P<0.05)。结论柔筋止痛针刺法治疗帕金森病伴发疼痛具有一定的临床疗效,对于改善帕金森病骨骼肌疼痛、不能静坐或坐立不安感导致的疼痛效果更好,对根性疼痛和运动障碍性疼痛效果不明显。

Objective To explore the effect of tendon-softening and pain-relieving acupuncture on different types of pain in Parkinson′s disease.Methods Eighty-four patients with Parkinson′s disease and pain were included.According to Chandhur pain classification standards,patients were classified into five pain groups,which were skeletal muscle pain(22 cases),radicular pain(10 cases),dyskinesia pain(34 cases),pain caused by inability to sit still or fidget(14 cases),and others(4 cases).All patients continued to be treated with conventional oral western medicine for Parkinson′s disease,stopped taking painkillers,and received tendon-softening and pain-relieving acupuncture.Even supplementation and drainage needling method was used,with needle retention for 30 minutes,once daily,5 times as a course for two courses.Traditional Chinese medicine(TCM)symptoms scores,visual analogue scale(VAS)score,King′s Parkinson′s disease pain scale(KPPS)score,unified Parkinson′s disease rating scale(UPDRS)score were assessed before and after treatment for different types of pain group.Results Of the 84 patients,no cases were clinically cured;21 cases were significantly improved;48 cases were moderately improved;five cases were slightly improved;and 10 cases were ineffective;the number of effective cases were 74,and the total effective rate was 88.1%.After treatment,the TCM symptoms score,VAS score,KPPS pain frequency score and total score,and UPDRS score all significantly decreased(P<0.05 or P<0.01).Due to the small number of patients with other types of pain,they were not included for subgroup analyses.After treatment,TCM symptoms score,VAS score,KPPS total score,and UPDRS score in skeletal muscle pain group significantly decreased(P<0.05 or P<0.01);in pain group caused by inability to sit still or fidget,the VAS score,KPPS total score and pain frequency score decreased(P<0.05 or P<0.01),while no significant change was seen in UPDRS score(P>0.05);there were no significant differences in the VAS score,KPPS score and UPDRS score of radicular pain and dyskinesia pain group after treatment(P>0.05),while TCM symptoms score in both significantly decreased after treatment(P<0.05).Conclusion Tendon-softening and pain-relieving acupuncture has certain effects on improving pain in patients with Parkinson′s disease;the effect is obvious for skeletal muscle pain and pain caused by inability to sit still or fidget,but is not significant for radicular pain and dyskinesia pain.