Clinical Evaluation And Related Factors Analysis Of Pain Symptoms In Parkinson's Disease

Objective:1.To preliminarily analyze the incidence,type and location of pain and other clinical characteristics in patients with Parkinson's disease(PD);2.To study the related influencing factors;3.Clinical comparison between Visual Analog Scale(VAS)and King's Parkinson's Disease Pain Scale(KPPS)for Pain assessment.Methods:Clinical data of 200 patients with primary PD(name,gender,age,course of disease,levodopa equivalent daily dose,etc.)were comprehensively collected.Part III of Unified Parkinson's Disease Rating Scale(UPDRS III),Hoehn and Yahr Scale(H-Y),mini-mental State Examination(MMSE),visual analogue Scale(VAS),King's Parkinson's pain Scale(KPPS),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Activity Daily Living Scale(ADL)and Pittsburgh Sleep Quality Index(PSQI)were used to assess patients' motor function,symptom severity,pain,cognitive function,anxiety status,self-care ability,depression and sleep disorder,respectively.Patients were divided into PD with pain group and without pain group,and each group was analyzed and compared.Results:1.The incidence of pain associated with Parkinson's disease was 44.5%,the average VAS score was(3.57 ±2.06),and the average KPPS score was(47.52 ±35.19).The pain sites of the patients were mostly lower extremities(60.7%),upper limbs(22.5%)and waist(21.3%),of which 24 cases(27%)were accompanied by two or more kinds of pain.The most common types of pain were skeletal muscle pain(61.8%)and dystonia(27%),including 17 patients(19.1%)with multiple types of pain.2.The course of disease(5.38 ±3.74 vs 4.18 ±3.56,P ? 0.022),levodopa equivalent daily dose(511.85±223.53 vs 420.74±253.85,P=0.008),UPDRSIII(24.83±7.79 vs 22.30±7.24,P=0.018),H-Y(2.60±1.03 vs 2.20±0.86,P=0.003),HAMA(15.47±5.26 vs 12.85±4.88,P<0.001),HAMD(21.39±8.82 vs 16.62±7.64,P<0.001),ADL(74.94±21.39 vs 80.50±17.66,P=0.046),and PSQI(10.37±5.26 vs 7.40±5.17,P<0.001)of PD with pain group compared with PD without pain group were significant differences.3.Multivariate Logistic stepwise regression analysis showed that PD patients with pain were correlated with H-Y grading score(mild(OR=1.000),moderate(OR=2.394,95% CI: 1.281-4.473,P=0.006),severe(OR=3.184,95% CI: 1.128-8.986,P=0.029))and PSQI score(OR=2.068,95% CI: 1.129-3.786,P=0.019),respectively.4.The Spearman correlation coefficient between VAS and KPPS was rs=0.884,P < 0.001;The weighted kappa coefficient of VAS and KPPS was 0.834(95% CI:0.742-0.927,P < 0.001);The area under the ROC curve(AUC)of KPPS was 0.795(95% CI: 0.691-0.900,P < 0.001),the maximum value of the Youden index was about 0.672,the corresponding sensitivity was about 84.6%,and the specificity was about 82.5%.Conclusions:1.Pain is a common non-motor symptom in PD patients,and its incidence is high.Skeletal muscle pain is the most common type of pain in PD patients;2.Patients with PD accompanied by pain have a longer course of disease,need a larger dose of dopamine drugs,have more severe dyskinesias and illnesses,are more prone to anxiety,depression and other emotional disorders,have lower daily life ability,and have poorer sleep quality;3.The severity of the disease and sleep disorders may be independent risk factors for pain;4.There is a positive correlation and strong consistency between VAS and KPPS.KPPS has certain accuracy.