Clinical Characteristics Of Pain And Fatigue In Parkinson’s Disease

Part I Observation on clinical characteristics of pain in Parkinson’s disease patientsObjective To assess the clinical features of chronic pain in patients with Parkinson’s disease(PD) for providing a clinical vidence for treating pain in PD patientsMethods 343 PD patients were enrolled in this study from January 2010 to July2013. All these patients came from outpatient of Department of Neurology in Second Affiliated Hospital of Soochow University. 150 age and gender matched healthy subjects were randomized to controls. Subjects were divided into two groups according to their pain complain or not in PD patients and controls. 50 healthy controls were found to have the symptoms of pain. Chronic pain of subjects in the two groups was assessed with visual analogue scale(VAS) and Brief pain inventory(BPI). We analyzed the pain localization, degree and treatment between 90 PD patients and 50 controls with chronic pain. Types of pain were analyzed in 68 PD patients with pain. Relationship between pain and patinets’ ON and OFF state、side of more severe motor symptoms, and gender were analyzed.Results The incidence of pain in PD patients was higher than that in healthy controls(47.8% vs 33.3% P=0.003); Most of pain in PD patients was morderate, and usually focused on the extremities. While pain in controls often located in necks and waists. Musculoskeletal pain was the most common type of pain in patients with PD.Nine patients(13.2%) reported more than one type of pain. Twelve PD patients complained that pain occurred when they were in the “OFF” state. The remaining patients with pain reported that the occurrence of pain had no correlation with the “ON”or “OFF” state. The pain located side did not correlate with the side that was mainly affected by PD. There were no gender differences in the incidence of pain(P=0.927).Conclusions Pain occurred more frequently in PD patients than those of controls.Most of pain in PD patients was morderate, and usually focused on the extremities.Musculoskeletal pain was the most common type of pain in PD patients. Pain located side was not associated with the side that was mainly affected by PD. Pain incidence was also no statistically significant between different gender.Part Ⅱ Relationship between pain and other non motor symptomsin Parkinson’s disease patientsObjective To observe the relationship between pain and a series of other non motor symptoms and summarize the clinical features of non motor symptoms in PD patients with pain for an optimizing treatment.Methods 142 PD patients were enrolled in this study from January 2012 to July2013. All these patients came from outpatient of Department of Neurology in Second Affiliated Hospital of Soochow University. The clinical diagnosis of PD matched the criteria of the United Kingdom Parkinson’s Disease Society Brain Bank. A questionnaire was designed to collect patients’ demographic data and other disease-related information. Motor and non-motor symptoms in patients with PD were evaluated using the Unified Parkinson’s Disease Rating Scale(UPDRS),Hoehn and Yahr Stage(H/Y), Hamilton Depression Rating Scale(HRSD; 24 items), Montreal Cognitive Assessment(Mo CA), and non-motor questionnaire(NMSQuest). The number of non-motor symptoms according to the NMSQuest was recorded as the NMSQT. Eighty healthy control subjects from our medical center also completed the NMSQuest.Results Compared to patients without pain, patients with pain had higer scoer of each part of UPDRS. Mean score of each part of UPDRS was 3.7, 12.6, 25.1, and 2.2Mean score of HRSD and Mo CA were 15.5 and 22.5 respectively. the prevalence of motor fluctuations and dyskinesia were higher in patients with pain than in patients without pain(P=0.001,P=0.011). Constipation(55.9%, 38/68) was the most prominent non-motor symptom in patients with PD and pain, followed by memory impairment(51.5%, 35/68). Logistic regression model showed that HRSD(P=0.000) and NMSQT(P=0.012) scores were associated with pain in patients with PD. Compared to patientswithout pain, patients with pain were more prone to have the symptoms of weight loss,remembering impaired, depression, insomnia and rapid eye movement behavior disorder.Conclusions PD patients with pain have severer motor symptoms than patients without pain. Non-motor symptoms were more prominent in patients with PD and pain.Patients with PD who had a greater number of non-motor symptoms seemed to be at higher risk of developing pain. Common brain region impairments affecting affective,cognitive, sleep, and autonomic function may explain the common occurrence of pain in patients with PD.Part Ⅲ Relationship between Fatigue and Depression in Parkinson’s DiseaseObjective To identify the association between fatigue and depression Which is helpful to recognize the characteristics of fatigue and depression in PD patients for the better management of PD patients.Methods 56 PD patients were enrolled in this study from June 2012 to October2012. All these patients came from outpatient of Department of Neurology in Second Affiliated Hospital of Soochow University. The clinical diagnosis of PD matched the criteria of the United Kingdom Parkinson’s Disease Society Brain Bank. A questionnaire was designed to collect patients’ demographic data and other disease-related information including disease onset, history of therapy, history of family,education and concomitant disease. Unified Parkinson’s Disease Rating Scale(UPDRS)Ⅲ and Hoehn-Yahr Scale were investigated to evaluate the disease severity.The degree of fatigue was measured by Fatigue Severity Scale(FSS). HRSD(24 items))was used to evaluate the degree of depression. PD Quality of Life Questionnaire( PDQL) were tested to evaluate the quality of life in PD patients.Results The incidence of fatigue in this group is 71.4%(40/56). In male patients,the incidence of fatigue was 73.7%, while in female patients, incidence of fatigue was66.7%. There were no difference in the incidence of fatigue between different gender(P=0.752). Multivariant stepwise regression analysis showed that score ofHAMD and PDQL exhibited a significant correlation to patients’ fatigue, coefficient of partial correlation was 0.451(P <0.01)、-0.346(P<0.05).The incidence of fatigue in non-depressive patients was low, 27.3%. While in depressive patients, the incidence of fatigue is relatively high, for mild depression 75%, moderate depression 100%, severe depression 100% respectively.Conclusion Fatigue was common in PD patients.Patients with fatigue were more depressive than patients without fatigue. Fatigue is a prominent symptom of depression in PD patients, sometimes may independent of depression. Fatigue was not associated with disease severity. Patients’ quality of life was also influenced by fatigue.