Pain characteristics and outcomes in patients with Parkinson′s disease / 中华神经科杂志

ABSTRACT

Objective:To investigate the clinical characteristics and influencing factors of pain symptoms in patients with idiopathic Parkinson′s disease.Methods:The King′s Parkinson′s Disease Pain Scale (KPPS) was used to evaluate pain of 106 patients with Parkinson′s disease. The Pittsburgh Sleep Quality Index (PSQI), the Fatigue Scale-14 (FS-14), the Unified Parkinson′s Disease Rating Scale Ⅲ, Hoehn-Yahr scale (H-Y), Mini-Mental State Examination (MMSE), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to assess the sleep status of patients, the degree of fatigue, motor function, severity of symptoms, cognitive function, anxiety and depression. Fifty-eight patients were followed up for three to six months.Results:The incidence of pain in Parkinson′s disease patients was 50.0% (53/106), of which skeletal muscle pain was the most common. Parkinson′s disease patients with a longer course of disease were more likely to have pain [course of disease in Parkinson′s disease with pain was 3.0 (1.5, 5.0) years, in Parkinson′s disease without pain was 2.0 (1.5, 2.5) years, Z=-2.0, P=0.046]. Male patients had more severe pain than female patients [KPPS scores in males were 14.5 (8.0, 21.5), in females were 10.0(4.0, 15.3), Z=-2.81, P=0.005]. In the first evaluation, the H-Y grading and the FS-14 scores of Parkinson′s disease patients with pain were significantly higher than those without pain [H-Y grading in Parkinson′s disease patients with pain was 2.0 (1.5, 2.5), in Parkinson′s disease patients without pain was 2.0 (1.5, 2.0), Z=-2.02, P=0.043; FS-14 scores in patients with pain were 10.0 (8.0, 11.0), in patients without pain was 8.0 (5.0, 10.0), Z=-3.32, P=0.001]. The KPPS scores were positively correlated with the scores of HAMA and HAMD ( r=0.39, P=0.005; r=0.38, P=0.007). Binary Logistic regression analysis showed that Parkinson′s disease patients with higher scores of FS-14 had an increased risk of developing pain ( OR=1.27, 95% CI 1.09-1.48, P=0.002). The changes of KPPS scores were associated with the changes of PSQI and FS-14 scores ( r=0.54, P=0.002; r=0.50, P=0.003). The decrease of KPPS scores was only positively correlated with the decrease of FS-14 scores when the drug and medication status remained unchanged ( r=0.421, P=0.045). Multiple linear regression analysis showed that the decrease of FS-14 scores was associated with the decrease of the KPPS scores ( OR=2.02, P=0.033). Conclusions:Parkinson′s disease patients have a high incidence of pain, and fatigue is a factor for predicting the occurrence and outcome of pain in Parkinson′s disease. The severity and change of pain in Parkinson′s disease patients are related to anxiety, depression, sleep and fatigue, suggesting that there may be a common pathogenesis of pain, emotion, sleep and fatigue in Parkinson′s disease patients.