Dor como sintoma não motor na doença de Parkinson: Epidemiologia descritiva da dor e avaliação de seu impacto na qualidade de vida

Abstract

Introduction: Parkinson's disease was described in 1817, with clinical characterization based on motor symptoms, but already in the description sleep disturbance, presence of pain, constipation and other non-motor symptoms were reported. Non-motor symptoms are being studied more and their impact on patients' lives often exceeds that of classic motor symptoms. Pain is one of them, despite being very prevalent without many therapeutic options and little objectively addressed in consultations. Objectives: to investigate the presence of pain and its impact on the quality of life of patients diagnosed with Parkinson's disease without advanced or moderate dementia. The secondary objectives were to correlate the presence of pain with other variables, such as depression scale, disease stage, non-motor symptoms scale and sleep scale. Methods: Observational cross-sectional study carried out after I or my advisor examined the patient during a medical appointment and later questionnaires were applied in person or over the phone. Demographic information was collected, such as: gender, age, age at diagnosis, initial symptom, duration of disease, education, presence of osteoarthritis, medications used to treat PD, equivalent dose of dopaminergics, use of antidepressants, presence or absence of pain and use and analgesics with dose and frequency. Motor symptoms of the disease were also evaluated according to the Unified Parkinson Disease Rating Scale (UPDRS) part III (Goetz, Power, et al., 2008), the stage of the disease according to the Hoehn Yahr (HY) scale (Hoehn & Yahr, 1967), evaluation of osteoarthritis according to the National Clinic Guideline Center 2008, evaluation of pain by four scales, the Ford scale, the King's Parkinson's Disease Pain Scale (KPPS), the Visual Analogue Scale (VAS), the PD-Pain Classification System (PD-PCS). Sleep was assessed using the Parkinson Disease Scale Sleep – PDSS; the presence of depressive symptoms was assessed using the Beck Depression Inventory. Quality of life was assessed using the Parkinson's Disease questionnaire (PDQ-39). Non-motor symptoms were assessed using the Non-Motor Rating Scale (NMS). Results: Pain variant was more frequent in patients with a younger diagnosis (p=0.013), and with a longer duration of disease (p=0.014). The PDSS value was higher in the group with pain, which translates to worse sleep quality, (p=0.006) and the PDQT was also higher in the group with pain p=0.001, which translates to a worse quality of life. A greater amount of non-motor symptoms observed in patients with pain, (p=0.017). There was a positive correlation between the KPSS and VAS pain scales and between KPSS and PD-PCS. PD-PCS was also correlated with NMS and PDQ-39. Conclusion: Pain was prevalent and was associated with worse quality of life, worse sleep quality, depression, longer illness and greater presence of non-motor symptoms.