Evaluation of Nociceptive Flexor Reflex Response in Patients with Painful Idiopathic Parkinson's Disease

Abstract

Aim: We aimed to investigate the utility of trigeminocervical reflex (TCR) and nociceptive flexion reflex (NFR) as objective measures for assessing pain—a common NMS—in patients with PD, targeting both the upper and lower body regions. Methods: All subjects were further classified into four groups: Group-I: Healthy individuals without PD or pain, Group-II: Individuals without PD but reporting non-specific musculoskeletal pain, Group-III: PD patients without pain, Group-IV: PD patients with pain as a NMS. The clinical assessment of PD was conducted using the Hoehn and Yahr Staging Scale (HYS) and the Unified Parkinson's Disease Rating Scale (UPDR). We divided the human body into upper and lower regions—utilizing the TCR for upper body pain and the NFR for pain around the lumbar and pelvic areas. Results: The Group-IV had a longer mean disease duration than those in Group-III (8.0±6.6 vs 3.0±3.5 and p=0.121). The mean UPDRS score significantly higher in Group-IV compared to Group-III (42.5±13 vs 27.4±15.3 and p=0.022). The mean VAS score was 7.0±0.7 in Group-II and 6.3±1.3 in Group-IV, with no significant differences in pain localization or VAS scores between the two-groups. Conclusion: Electrophysiological reflex assessments do not appear to be sufficiently reliable in evaluating pain perception in these patients.

Keywords

• Parkinson’s disease
• Pain
• Nociceptive flexion reflex

Ağrılı İdiyopatik Parkinson Hastalığı Olan Hastalarda Nosiseptif Fleksör Refleks Tepkisinin Değerlendirilmesi

Öz

Amaç: Parkinson hastalığı (PH) hastalarında, yaygın bir NMS olan ağrıyı değerlendirmede, hem üst hem de alt vücut bölgelerini hedef alan objektif ölçümler olarak trigeminoservikal refleks (TCR) ve nosiseptif fleksiyon refleksinin (NFR) kullanılabilirliğini araştırmayı amaçladık. Metot: Tüm denekler dört gruba ayrıldı: Grup I: PH veya ağrısı olmayan sağlıklı bireyler, Grup II: PH olmayan ancak spesifik olmayan kas-iskelet sistemi ağrısı bildiren bireyler, Grup III: Ağrısı olmayan PH hastaları, Grup IV: NMS olarak ağrısı olan PH hastaları. PH'nin klinik değerlendirmesi Hoehn ve Yahr Evreleme Ölçeği (HYS) ve Birleşik Parkinson Hastalığı Derecelendirme Ölçeği (UPDR) kullanılarak yapıldı. İnsan vücudunu üst ve alt bölgelere ayırdık; üst vücut ağrısı için TCR'yi, bel ve pelvik bölgelerdeki ağrı için ise NFR'yi kullandık. Sonuçlar: Grup IV'teki hastaların ortalama hastalık süresi Grup III'teki hastalardan daha uzundu (8,0±6,6'ya karşı 3,0±3,5 ve p=0,121). Ortalama UPDRS skoru Grup IV'te Grup III'e kıyasla anlamlı derecede yüksekti (42,5±13'e karşı 27,4±15,3 ve p=0,022). Ortalama VAS skoru Grup II'de 7,0±0,7, Grup IV'te ise 6,3±1,3 idi ve iki grup arasında ağrı lokalizasyonu veya VAS skorları arasında anlamlı bir fark yoktu. Sonuç: Elektrofizyolojik refleks değerlendirmeleri, bu hastalarda ağrı algısını değerlendirmede yeterince güvenilir görünmemektedir.

Anahtar Kelimeler

• Parkinson hastalığı
• Ağrı
• Nosiseptif fleksiyon refleksi

Kaynakça

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