Pain in Parkinson’s disease: exercise and pain management

Abstract

The thesis investigates pain management and exercise for people with Parkinson’s disease, aiming to address gaps in traditional pharmacological approaches by considering biopsychosocial factors and non-pharmacological strategies. Five studies were conducted:

Study 1. A systematic review with meta-analyses revealed that exercise had a small effect on reducing pain (PDQ-39 bodily discomfort subscore) post-intervention compared to control (Hedge’s G 0.15; 95% CI, 0.02 to 0.28) in people with Parkinson’s disease. Aquatic exercise reduced pain rated on a visual analogue scale compared to multimodal exercise post-intervention (Hedges’ G 0.77; 95% CI = 0.35 to 1.19). However, the certainty of evidence for all meta-analyses was very low, necessitating further research.

Study 2 and 3. Exercise-induced hypoalgesia was demonstrated in people with Parkinson’s disease following isometric and low/moderate intensity aerobic exercises, indicating safe exercise options without increasing pain sensitivity.

Study 4. Exploration of associations between pain and various factors found that increased physical activity and reduced sedentary time, poor sleep, anxiety, and depression are associated with worse pain in people with Parkinson’s disease. Increased physical activity unexpectedly linked to worsened pain, challenging previous findings.

Study 5. A broader biopsychosocial approach demonstrated that multiple pain contributors, thoughts, beliefs, and sense of control influence chronic pain experiences and management in individuals with Parkinson’s disease.

Taken together, these findings underscore the importance of tailored, biopsychosocial approaches to pain management, emphasising individual needs. Further research should investigate tailored exercise strategies and explore the interplay between physical activity, pain perception, and individual experiences to optimise pain management for people with Parkinson’s disease.