Study On The Influencing Factors Of Pain In Parkinson’s Disease

Objective:1.To analyze the clinical features and related factors of pain associated with Parkinson ’s disease(PD);2.Preliminary study on the effect of the echo changes of brainstem raphe(BR)observed detected by transcranial ultrasound(TCS)on the pain in PD.Method:1.A total of 86 PD patients who were admitted to the Parkinson’s Disease Clinic of our hospital from September 2020 to December 2020 were included in this study.Collect general clinical data of all patients,such as gender,age,education level,onset side,exercise subtype,disease course,symptom fluctuation and so on.Check the following scales for all patients:(1)Hoehn-Yahr Stage(H-Y staging)(2)Unified Parkinson’s disease rating scale-III(UPDRS-III)(3)Argentina Hypoosmia Rating Scale(AHRS)(4)Mini-Mental State Examination(MMSE)(5)Hamilton’s Depression Scale(HAMD)(6)Hamilton’s Anxiety Rating Scale(HAMA)(7)Pittsburgh Sleep Quality Index(Pittsburgh Sleep Quality Index,PSQI)(8)Autonomic Symptom Scale(9)Specific King’s Parkinson Disease Pain Scale(KPPS)(10)Parkinson’s Disease Quality of Life Questionnaire-39(PDQL-39).All enrolled patients underwent TCS examination and recorded their substantia nigra echo level and raphe nucleus echo level.2.According to the scores of the KPPS scale,the PD patients are divided into the pain-associated group and the non-pain group,and the severity of the patients with PD-associated pain is evaluated;according to the classification method of pain in the KPPS scale,statistical analysis of the occurrence of different types of pain frequency.3.Using a single factor analysis method,analyze the difference between the above-collected clinical data between the PD-associated pain group and the non-pain group,and study the possible influencing factors of PD-associated pain.For categorical variables(gender,education level,onset side,motor subtype,H-Y stage,symptom fluctuation,olfactory disturbance,substantia nigra echo change,raphe nucleus echo change)for univariate analysis,the chi-square test method was used.When performing univariate analysis for continuous variables(age,disease course,UPDRS-III,MMSE,HAMD,HAMA,PSQI,PDQL-39),the Shapiro-Wilk test method is used to test the normality of the above continuous variables,which obeys normal distribution The continuous variables of using the independent sample T test method;the continuous variables that do not obey the normal distribution use the nonparametric test method of two independent samples.According to univariate analysis,there is a significant difference(P<0.05)between the PD-associated pain group and the non-pain group,which are the possible influencing factors of PD-associated pain.4.For the above-mentioned suspicious influencing factors of PD-associated pain detected by the single-factor analysis method,multi-factor analysis can be included,and the binary logistic regression analysis method can be selected to further study the independent effects of PD-associated pain(protection/risk)Factors(P<0.05).Results:1.A total of 86 PD patients participated in the study,of which 51 were in the PD-associated pain group and 35 were in the non-pain group.The incidence of pain in PD patients was 65.38%(51/86).The KPPS score of the PD with pain group ranged from 1-42 points,with an average of 14.19±9.79 points.The most common type of pain in PD patients with pain is skeletal myalgia(40 cases,78.43%);followed by chronic pain(35 cases,68.63%),nerve root pain(28 cases,54.90%),swelling pain(23 cases,45.09%),pain related to symptom fluctuation(12 cases,23.53%),night pain(8 cases,15.69%),orofacial pain(7 cases,13.73%).2.Comparison of clinical data between the PD-associated pain group and the non-pain group.Single factor analysis found that the two groups had differences in 7variables: gender,HY staging,HAMD,HAMA,PSIQ,olfactory dysfunction,and raphe nucleus echo changes.It is statistically significant(P<0.05),indicating that these 7 variables are suspected influencing factors of PD associated with pain.The specific analysis results are as follows:(1)Gender(statistical value=5.985,P=0.014<0.05);(2)H-Y staging(statistical value=3.956,P=0.047<0.05);(3)HAMD(statistical value=13.265,P < 0.001);(4)HAMA(Statistical value=9.243,P=0.002<0.05);(5)PSIQ(statistical value=6.951,P=0.008<0.05);(6)Small dysfunction(statistical value=4.072,P=0.004<0.05);(7)Echo changes of raphe nucleus(statistic Value=6.387,P=0.011<0.05).3.The 7 suspected influencing factors of PD associated with pain(gender,HY staging,HAMD,HAMA,PSIQ,olfactory dysfunction,and changes in raphe nucleus echo)from the above single factor analysis were incorporated into the multivariate analysis,and binary Logistic regression was used.Methods,the results found that the four factors of gender,HY stage,HAMD score,and raphe nucleus changes were independent influencing factors of PD-associated pain(P<0.05).The specific results are as follows:(1)Women are an independent risk factor for PD associated with pain.Female PD patients are 4.682 times more likely to have pain associated with PD(P=0.015,OR=4.682);(2)H-Y staging(3-5 stages))Is an independent risk factor for pain associated with PD.Patients with advanced PD are 8.331 times more likely to have pain associated with early and mid-term patients(P=0.009,OR=8.331);(3)HAMD score is an independent risk factor for pain associated with PD,HAMD The higher the score,the more severe the depression,and the greater the risk of PD associated with pain(P=0.031,B=0.112>0,OR=1.010);(4)The abnormal echo of the raphe nucleus under TCS is an independent risk factor for PD associated with pain.PD patients with abnormal raphe nucleus echo are 3.931 times more likely than patients with normal raphe nucleus echo(P=0.015,OR=3.931).Conclusion :1.Pain is a common non-motor symptom of PD,with a high incidence in PD patients;skeletal muscle pain is the most common type of pain,followed by chronic pain,radiculopathy,swelling pain,pain related to symptom fluctuations,and nighttime Pain,oral and facial pain.2.Gender,H-Y staging,degree of depression,degree of anxiety,quality of sleep,,and olfactory disturbance are possible influencing factors for the pain associated with PD.3.Female,H-Y staging and HAMD score are independent risk factors for PD associated with pain,that is,female PD patients are more likely to be associated with pain;the higher the H-Y staging,the more severe the depression,and the greater the possibility of PD associated with pain.4.The changes in the echo of the raphe nucleus under TCS are related to the pain in PD,and PD patients with abnormal echoes of the raphe nucleus are more likely to have pain.