Neurology, Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre, Toronto, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Acta Neurol Scand. 2021 Aug;144(2):115-131. doi: 10.1111/ane.13435. Epub 2021 May 13.
Among the various non-motor symptoms of Parkinson's disease (PD), pain is often cited as the most common and debilitating feature. Currently, the literature contains gaps in knowledge with respect to the various forms of treatment available, particularly non-pharmacological therapies. Thus, the purpose of this systematic review is to provide an examination of the literature on non-pharmacological therapies for pain in PD. We compared the findings of research articles indexed within various literature databases related to non-pharmacological treatments of pain in PD patients. Our review identified five major non-pharmacological methods of pain therapy in PD: acupuncture, hydrotherapy, massage therapy, neuromodulation, and exercise. Treatments such as exercise therapy found a reduction in pain perception due to various factors, including the analgesic effects of neurotransmitter release during exercise and increased activity leading to a decrease in musculoskeletal rigidity and stiffness. By the same token, hydrotherapy has been shown to reduce pain perception within PD patients, with authors often citing a combined treatment of exercise and hydrotherapy as an effective treatment for pain management. Multiple methods of neurostimulation were also observed, including deep brain stimulation and spinal cord stimulation. Deep brain stimulation showed efficacy in alleviating certain pain types (dystonic and central), while not others (musculoskeletal). Hence, patients may consider deep brain stimulation as an additive procedure for their current treatment protocol. On the other hand, spinal cord stimulation showed significant improvement in reducing VAS scores for pain. Finally, although the literature on massage therapy and acupuncture effectiveness on pain management is limited, both have demonstrated a reduction in pain perception, with common reasons such as tactile stimulation and release of anti-nociceptive molecules in the body. Although literature pertaining to non-pharmacological treatments of pain in PD is sparse, there is copious support for these treatments as beneficial to pain management. Further exploration in the form of clinical trials is warranted to assess the efficacy of such therapies.
在帕金森病（PD）的各种非运动症状中，疼痛常被认为是最常见和最具致残性的特征。目前，文献中存在关于现有各种治疗方法的知识空白，特别是非药物治疗方法。因此，本系统综述的目的是对 PD 患者疼痛的非药物治疗文献进行检查。我们比较了各种文献数据库中索引的研究文章中关于 PD 患者疼痛的非药物治疗的研究结果。我们的综述确定了 PD 中疼痛治疗的五种主要非药物方法：针灸、水疗、按摩疗法、神经调节和运动。运动疗法等治疗方法由于各种因素导致疼痛感知降低，包括运动期间神经递质释放的镇痛作用以及活动增加导致的肌肉骨骼僵硬和僵硬减少。同样，水疗已被证明可以降低 PD 患者的疼痛感知，作者经常引用运动和水疗相结合的治疗方法作为疼痛管理的有效治疗方法。还观察到多种神经刺激方法，包括深部脑刺激和脊髓刺激。深部脑刺激对缓解某些类型的疼痛（痉挛性和中枢性）有效，而对其他类型（肌肉骨骼性）无效。因此，患者可能会考虑将深部脑刺激作为其当前治疗方案的附加程序。另一方面，脊髓刺激显示出显著改善疼痛 VAS 评分的效果。最后，尽管关于按摩疗法和针灸治疗疼痛管理效果的文献有限，但两者都已证明可以降低疼痛感知，常见的原因是触觉刺激和体内抗伤害性分子的释放。尽管关于 PD 中疼痛的非药物治疗的文献很少，但有大量证据支持这些治疗方法对疼痛管理有益。需要进一步进行临床试验来评估这些疗法的疗效。
Zotero 插件