Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands.
J Parkinsons Dis. 2024;14(s1):S65-S80. doi: 10.3233/JPD-230227.
Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.
疼痛是一种痛苦且普遍的体验，但每个人的疼痛体验都受到一系列复杂的生物、心理和社会因素的影响。对于帕金森病患者（PwP），这些生物心理社会因素包括神经退行性变以及除了一般人群中经历的因素（例如，与骨关节炎等共病共存）之外，还包括与慢性神经退行性疾病共存的心理和社会因素。这些因素对每个人的影响方式可能决定了哪些疼痛管理策略对他们最有效。本综述首先描述了疼痛和疼痛的生物心理社会模型。它探讨了疼痛在帕金森病（PD）中的分类，并描述了三种主要类型的疼痛：伤害性疼痛、神经性疼痛和神经病理性疼痛。这为讨论可能有助于管理 PwP 疼痛的非药物性疼痛管理策略提供了背景；运动、心理策略、针灸和按摩。虽然很少有特定于 PD 的研究来为疼痛的非药物管理提供信息，但从当前 PD 研究中获得的结果与慢性疼痛研究相结合，提出了临床实践建议。建议包括评估可能导致疼痛的潜在生物心理社会因素，然后指导采用整体、多模式的管理方法。由于运动对 PwP 有整体益处，因此应仔细监测患有慢性疼痛的患者，并相应地进行运动处方和调整。需要研究开发和评估在生物心理社会框架下实施的多模式疼痛管理方法。
