Recognize Common Non-motor Symptoms Of Parkinson's Disease - Pain

The common symptoms of Parkinson's disease patients are divided into two categories: motor symptoms and non-motor symptoms. Typical motor symptoms include resting tremors, muscle rigidity, bradykinesia, and abnormal posture and gait, which have been used as the main basis for clinical diagnosis. With the in-depth study of the disease, non-motor symptoms including olfactory disturbance, sleep disturbance, constipation, pain, mental symptoms, etc. have received more and more attention. Among them, pain is very common in Parkinson's disease, with an incidence of 40% to 85%, and is considered to be one of the main factors that reduce the quality of life of patients with Parkinson's disease. Previous studies have shown that the cause of pain in patients with Parkinson's disease may be related to the impairment of nociceptive pathways during processing, including neural circuits (such as cortico-basal ganglia-thalamic circuits), sensory ascending/descending pathways, Neurotransmitters (such as dopamine, serotonin, gamma-aminobutyric acid, etc.).

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Parkinson's pain mostly occurs in the lower limbs or back, which seriously affects the quality of life of patients. The type of pain can be divided into musculoskeletal pain, dystonia, radicular pain, central pain, and akathisia. The mechanisms of different types of pain may be different. Musculoskeletal pain may be related to peripheral factors such as myotonia, bradykinesia, abnormal posture, and skeletal deformities, while central pain is considered to be a direct consequence of Parkinson's disease and may be related to the basal ganglia-thalamus- Cortical circuits, basal ganglia sensory circuits, and diencephalic spinal pathways are related to dysfunction.

      (1) Musculoskeletal muscle pain: The clinical manifestations are mainly muscle spasmodic pain and arthralgia, and the nature of the pain is mainly soreness. Muscle spastic pain occurs mostly in the paraspinal, neck, and small muscles; joint pain includes shoulder, hip, knee, and ankle joints. For example, frozen shoulders may cause pain symptoms due to the accumulation of lactic acid due to continuous muscle contraction. Joint pain in patients with Parkinson's disease is often misdiagnosed as arthritis, delaying treatment.

     (2) Muscle tension-related pain: muscle rigidity pain accompanied by muscle contraction or abnormal local posture and continuous torsional movement, which can occur in the limbs, pharynx, and facial muscles, usually occurs during the drug off period, and can be relieved after activity, which was significantly correlated with dopamine-induced fluctuations in motor symptoms.

     (3) Radical pain: The pain is sharp pain along the distribution area of the nerve root, mainly manifested as discharge-like pain in the extremities, and can also be manifested as numbness and tingling in the fingers and toes. The pain area is not limited to the nerve distribution area, it can be Is acute or chronic and may be more severe with standing and sitting, relieved with lying down. Notably, some patients experience these symptoms not because of a herniated disc, but because of severe musculoskeletal stiffness and stretched motor nerves from the abnormal posture.

     (4) Central pain: It is characterized by indescribable and unfixed pain, including superficial acupuncture and burning sensations, as well as internal body discomfort and autonomic symptoms, which seriously affects the patient's quality of life.

     (5) Pain caused by akathisia or restlessness: It usually occurs at night, and the patient is restless and must keep the legs moving, which can affect sleep in severe cases. The pain caused by akathisia is more like a feeling of discomfort, which is easy to be confused with restless legs syndrome, and the incidence of restless legs syndrome in Parkinson's disease patients is significantly higher than that in the general population, but the relationship between the two Further research is required.

     The clinical manifestations of pain are diverse, and the prevalence from high to low is musculoskeletal pain, dystonic pain, radicular pain, and central pain. Current research suggests that the pain mechanism of Parkinson's disease is a decrease in pain threshold and tolerance, especially in the off period.

In the treatment of Parkinson's pain, in addition to adjusting Parkinson's drugs, traditional Chinese medicine, acupuncture, external application of traditional Chinese medicine, and TCM-guided exercise also play an important role in the treatment of Parkinson's disease complicated by "pain", and it is safe. Side effects are small.

Echinacoside in Cistanche can improve the behavioral defects of MPTP-induced PD model mice, increase the striatal dopamine (DA) metabolite 3,4-dihydroxypheny lacetic acid (3,4-dihydroxypheny lacetic acid, DOPAC), and high Vanillic acid (homovanillic acid, HVA) content significantly inhibits the apoptosis of cerebellar granule neurons caused by the activation of caspase-3 and caspase-8; reduces the overexpression of biliverdin reductase B in the brain of Parkinson's patients, suggesting Echinacoside may reduce the increase of biliverdin reductase B caused by oxidative stress through its anti-oxidative stress effect, and protect dopaminergic neurons from oxidative stress damage. Its neuroprotective mechanism may be similar to that of bile Decreased levels of chlorophyll reductase B are related; to the reduction of dopaminergic neurons and dopamine transporters in the substantia nigra of the brain of patients with Parkinson's disease, and can enhance neurotrophic factor [neurotrophic factor, NTF. brain-derived neurotrophic factor, BDNF) and nerves The activity and protein expression level of glial cell line-derived neurotrophic factor (GDNF) derived from the glial cell line can reduce the ratio of mRNA and protein in apoptosis and Bax/Bcl-2. In addition, echinacoside can significantly increase the content of dopamine, DOPAC, and HVA in the extracellular fluid of the striatum of patients with Parkinson's disease.

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