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Physical therapy interventions to manage pain in Parkinson’s disease: A systematic review
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Department of Prevention and Rehabilitation in Physical Therapy, The Federal University of Paraná, Paraná, Brazil
Department of Physical Education, The Federal University of Paraná, Paraná, Brazil
Submission date: 2022-12-20
Acceptance date: 2023-06-04
Publication date: 2023-08-04
Hum Mov. 2023;24(3):31-43
Pain is a common non-motor symptom in Parkinson’s disease (PD), affecting about 40% of this population. Non-drug treatments and physical exercises, including physical therapy, are recommended options to ease PD pain. However, there are gaps in the literature regarding the treatment of this symptom, as well as few clinical trials assessing possible physical therapy interventions to manage PD pain. Hence, the objective of this study was to verify and analyse the physical therapy treatments available in the literature to manage pain in PD patients.

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), searching the PEDro, PubMed, SciELO, and Science Direct databases.

After applying the eligibility criteria, nine clinical trials remained, whose total sample comprised 242 individuals with PD (Hoehn and Yahr stage 1 to 4), submitted to physical therapy resources and methods such as hydrotherapy, physical therapy exercises, gait training with body weight support, electroacupuncture, and massage.

All the articles had positive physical therapy results in treating pain in people with PD. It is concluded that land and aquatic physical therapy methods improve the levels of pain in PD patients. However, further studies are needed with larger samples, who should be followed up to verify the duration of the effects.

Over L, Bruggemann N, Lohmann K. Therapies for genetic forms of Parkinson’s disease: systematic literature review. J Neuromuscul Dis. 2021;8(3):341–356; doi: 10.3233/JND-200598.
Tai Y, Lin C. An overview of pain in Parkinson’s disease. Clin Park Relat Disord. 2019;2:1–8; doi: 10.1016/j. prdoa.2019.11.004.
Beiske A, Loge JH, Ronningen A, Svensson E. Pain in Parkinson’s disease: prevalence and characteristics. Pain. 2009;141(1–2):173–177; doi: 10.1016/j.pain.2008. 12.004.
Buhmann C, Wrobel N, Grashorn W, Fruendt O, Wesemann K, Diedrich S, et al. Pain in Parkinson disease: a cross-sectional survey of its prevalence, specifics, and therapy. J Neurol. 2017;264(4):758–769; doi: 10.1007/ s00415-017-8426-y.
Pinto AH, Lange C, Pastore CA, Llano PMP, Castro DP, Santos F. Functional capacity to perform activities of daily living among older persons living in rural areas registered in the Family Health Strategy. Cien Saude Colet. 2016;21(11):3545–3555; doi: 10.1590/1413- 812320152111.22182015.
Reis LA, Torres G. Influence of chronic pain in the functional capacity of institutionalized elderly [in Portuguese]. Rev Bras Enferm. 2011;64(2):274–280; doi: 10.1590/s0034-71672011000200009.
DeSantana JM, Souza JB, Reis FJJ, Gosling AP, Paranhos E, Barboza HFG, et al. Pain curriculum for graduation in physiotherapy in Brazil. Rev Dor. 2017;18(1); 72–78; doi: d10.5935/1806-0013.20170015.
Allen NE, Moloney N, van Vliet V, Canning C. The rationale for exercise in the management of pain in Parkinson’s disease. J Parkinsons Dis. 2015;5(2):229–239; doi: 10.3233/JPD-140508.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535; doi: 10.1136/bmj.b2535.
Ross R. Clinical assessment of pain. In: Deusen J, Brunt D (eds.) Assessment in Occupational Therapy and Physical Therapy. Philadelphia: WB Saunders; 1997:123–133.
Todd KH. Pain assessment instruments for use in the emergency department. Emerg Med Clin North Am. 2005;23(2):285–295; doi: 10.1016/j.emc.2004.12.002.
Hunt SM, McKenna SP, McEwen J, Williams J, Papp E. The Nottingham health profile: subjective health status and medical consultations. Soc Sci Med A. 1981;15(3pt1): 221–229; doi: 10.1016/0271-7123(81)90005-5.
Gaston-Johansson F. Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices. J Pain Symptom Manage. 1996;12(3): 172–181; doi: 10.1016/0885-3924(96)00128-5.
Peto V, Jenkinson C, Fitzpatrick R, Greenhall R. The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease. Qual Life Res. 1995;4(3):241–248; doi: 10.1007/ BF02260863.
Ware JE, Sherbourne CD. The MOS 36-item shortform health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483.
Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil. 1986;67(6):387–389.
Goetz CG, Liu Y, Stebbins GT, Wang L, Tilley BC, Teresi JA, et al. Gender-, age-, and race/ethnicity-based differential item functioning analysis of the movement disorder society-sponsored revision of the Unified Parkinson’s disease rating scale. Mov Disord. 2016;31(12): 1865–1873; doi: 10.1002/mds.26847.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12; doi: 10.1016/ 0197-2456(95)00134-4.
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8): 713–721. PMID: 12882612.
Perez-de la Cruz S. Effectiveness of aquatic therapy for the control of pain and increased functionality in people with Parkinson’s disease: a randomized clinical trial. Eur J Phys Rehabil Med. 2017;53(6):825–832; doi: 10.23736/S1973-9087.17.04647-0.
Perez-de la Cruz S. A bicentric controlled study on the effects of aquatic Ai Chi in Parkinson disease. Complement Ther Med. 2018;36:147–153; doi: 10.1016/j. ctim.2017.12.001.
Perez-de la Cruz S. Mental health in Parkinson’s disease after receiving aquatic therapy: a clinical trial. Acta Neurol Belg. 2019;119(2):193–200; doi: 10.1007/ s13760-018-1034-5.
Atan T, Taşkıran OO, Tokcaer AB, Karataş GK, Calışkan AK, Karaoğlan B. Effects of different percentages of body weight-supported treadmill training in Parkinson’s disease: a double-blind randomized controlled trial. Turk J Med Sci. 2019;49(4):999–1007; doi: 10.3906/sag-1812-57.
Lena F, Iezzi E, Etoom M, Santilli M, Centonze D, Foti C, et al. Effects of postural exercises in patients with Parkinson’s disease and Pisa syndrome: a pilot study. NeuroRehabilitation. 2017;41(2):423–428; doi: 10.3233/ NRE-162033.
Toosizadeh N, Lei H, Schwenk M, Sherman SJ, Sternberg E, Mohler J, et al. Does integrative medicine enhance balance in aging adults? Proof of concept for the benefit of electroacupuncture therapy in Parkinson’s disease. Gerontology. 2015;61(1):3–14; doi: 10.1159/ 000363442.
Lei H, Toosizadeh N, Schwenk M, Sherman S, Karp S, Sternberg E, et al. A pilot clinical trial to objectively assess the efficacy of electroacupuncture on gait in patients with parkinson’s disease using body worn sensors. PLoS One. 2016;11(5):e0155613; doi: 10.1371/ journal.pone.0155613.
Gandolfi M, Tinazzi M, Magrinelli F, Busselli G, Dimitrova E, Polo N, et al. Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson’s disease: a single-blinded, randomized controlled trial. Parkinsonism Relat Disord. 2019;64:268–274; doi: 10.1016/j.parkreldis.2019.05.006.
Skogar O, Borg A, Larsson B, Robertsson L, Andersson L, Andersson L, et al. “Effects of Tactile Touch on pain, sleep and health related quality of life in Parkinson’s disease with chronic pain”: a randomized, controlled and prospective study. Eur J Integr Med. 2013; 5(2):141–152; doi: 10.1016/j.eujim.2012.10.005.
Thompson T, Gallop K, Correll CU, Carvalho AF, Veronese N, Wright E, et al. Pain perception in Parkinson’s disease: a systematic review and meta-analysis of experimental studies. Ageing Res Rev. 2017;35:74–86; doi: 10.1016/j.arr.2017.01.005.
Valkovic P, Minar M, Singliarova H, Harsany J, Hanakova M, Martinkova J, et al. Pain in Parkinson’s disease: a cross-sectional study of its prevalence, types, and relationship to depression and quality of life. PLoS One. 2015;10(8):e0136541; doi: 10.1371/journal.pone.013 6541.
Coriolano M, Balbino J, Silva B, Cabral E, Asano A, Lins O, et al. Pain characterization in patients with Parkinson’s disease. Rev Dor. 2014;15(2):78–82; doi: 10.5935/1806-0013.20140019.
Fil A, Cano-de-la-Cuerda R, Munoz-Hellin E, Vela L, Ramiro-Gonzalez M, Fernandez-de-Las-Penas C. Pain in Parkinson disease: a review of the literature. Parkinsonism Relat Disord. 2013;19(3):285–294; doi: 10.1016/ j.parkreldis.2012.11.009.
Keus S, Munneke M, Graziano M, Paltamaa J, Pelosin E, Domingos J, et al. European Physiotherapy Guideline for Parkinson’s Disease. Amsterdam: KNGF/Parkinson Net; 2014.
Silva D, Nunes M, Oliveira J, Coriolano M, Berenguer F, Lins O, et al. Effects of aquatic physiotherapy on life quality on subjects with Parkinson disease. Fisioter Pesqui. 2013;20(1):17–23; doi: 10.1590/S1809-29502 013000100004.
Bates A, Hanson N. Aquatic exercise therapy [in Portuguese]. In: Bates A, Hanson N. Fibromyalgia syndrome and exercise aquatic [in Portuguese]. Sao Paulo: Manole; 1998:285–299.
Pereira SAP. Hydrokinesiotherapy and its influence on the quality of life of patients with fibromyalgia [in Portuguese]. Fisioter Bras. 2014;15(1):56–62; doi: 10.33233/fb.v15i1.314.
Antunes MD, Vertuan MP, Miquilin A, Leme DE, Morales RC, Oliveira DV. Effects of Watsu on quality of life and pain in elderly women with fibromyalgia [in Portuguese]. Cons Saude. 2016;15(4):636–641; doi: 10.5585/conssaude.v15n4.6756.
Silva JP, Jesus-Moraleida F, Felicio DC, Queiroz BZ, Ferreira ML, Pereira LSM. Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study. Cien Saude Colet. 2019; 24(7):2679–2690; doi: 10.1590/1413-81232018247.14 172017.
Sobrinho AC, Almeida ML, Rodrigues G, Bueno CR. Association of chronic pain with strength, levels of stress, sleep and quality of life in women over 50 years. Fisioter Pesqui. 2019;26(2):170–177; doi: 10.1590/18 09-2950/18033226022019.
Garza-Villarreal EA, Wilson AD, Vase L, Brattico E, Barrios FA, Jensen TS, et al. Music reduces pain and increases functional mobility in fibromyalgia. Front. 2014;5(90); doi: 10.3389/fpsyg.2014.00090.
Siega J, Paladini LH, Graefling BCF, Israel VL. Scoping review: how do the properties of heated water influence the prescription of aquatic physical exercises to develop motor skills in people with Parkinson’s disease? Hum Mov. 2023;24(1):56–66; doi: 10.5114/hm.2023.110752.
Rodriguez-Carrillo JC, Ibarra M. Depression and other affective disorders in Parkinson’s disease [in Spanish]. Acta Neurol Colomb. 2019;35(1):53–62.
Yu W, Yang Q, Wang X. The mechanism of exercise for pain management in Parkinson’s disease. Front Mol Neurosci. 2022;15:1039302; doi: 10.3389/fnmol.2022. 1039302.
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of cochrane reviews. Cochrane Database Syst Rev. 2017;24;4(4):CD011279; doi: 10.1002/14651858.CD011279.pub3.
Castro Soares KVB, Silva AL, Lima JMMP, Nunes WJ, Calomeni MR, Silva VF. Fisiomotricity and threshold of pain: effects of a physical exercise program in the functional autonomy of osteoporotic elderly woman [in Portuguese]. Fisioter Mov. 2010;23(1):161–172; doi: 10.1590/S0103-51502010000100016.
Gosling AP. Physical therapy action mechanisms and effects on pain management. Rev Dor. 2012;13(1):65– 70; doi: 10.1590/S1806-00132012000100012.
Goncalves BM, Barezani, ALS, Feital AMB, Souza MS, Christo PP, Scalzo PL. Low back pain prevalence in Parkinson’s disease. BrJP. 2020;3(4):310–313; doi: 10.5935/2595-0118.20200192.
Rosarion CL. Exercise therapy for a patient with Parkinson disease and back pain: a case report. J Chiropr Med. 2018;17(1):72–74; doi: 10.1016/j.jcm.2017.10.008.
Feital AMB, Goncalves BM, Souza TM, Christo MP, Scalzo PM. Pilates method for low back pain in individuals with Parkinson’s disease: a feasibility study. J Bodyw Mov Ther. 2022;32:19–28; doi: 10.1016/j.jbmt. 2022.05.020.
Notarnicola A, Fischetti F, Maccagnano G, Comes R, Tafuri S, Moretti B. Daily Pilates exercise or inactivity for patients with low back pain: a clinical prospective observational study. Eur J Phys Rehabil Med. 2014; 50(1):59–66.
Natour J, Cazotti L, Ribeiro LH, Baptista AS, Jones A. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2015;29(1):59–68; doi: 10.1177/0269215514538981.
Kun PA, Oliveira DV, Franco MF, Antunes MD, Pina FLC. The Pilates method in pain improvement: a systematic review [in Portuguese]. Revista Valore. 2020;5(1):e-5005; doi: 10.22408/reva502020261e-5005.
Yamada EF, Risso TT, Wittmer VL, Ligorio MW. Influence of physical activity in elderly flexibility [in Portuguese]. Cid Acao Rev Ext Cult. 2021;6(1).
Hopwood V, Loversey M, Mokone S (eds.). Acupuncture and Related Techniques in Physical Therapy. Churchill Livingstone, 1997; 2001.
Mayor D. An exploratory review of the electroacupuncture literature: clinical applications and endorphin mechanisms. Acupunct Med. 2013;31(4):409–415; doi: 10.1136/acupmed-2013-010324.
Carvalho R. Influence of electroacupuncture on pain perception, functional performance, local temperature and plasma inflammatory mediators in patients with chronic low back pain seen by the SUS [in Portuguese]. 2016. Dissertation (Master in Biosciences Applied to Health). Alfenas: Federal University of Alfenas; 2016.
Rubert VA, Reis DC, Esteves AC. Parkinson’s disease and physical exercise. Rev Neurocienc. 2007;2(15):141–146; doi: 10.34024/rnc.2007.v15.10279.
Zuppa C, Cardoso FO, de Macedo E, Bos Angelo JG. Improvement in gait performance in oldest-old with chronic pain, after acupuncture intervention [in Portuguese]. PAJAR. 2018;6(1):8–14; doi: 10.15448/2357- 9641.2018.1.29062.
Edinoff A, Sathivadivel N, McBride T, Parker A, Okeagu C, Kaye AD, et al. Chronic pain treatment strategies in Parkinson’s disease. Neurol Int. 2020;12(3):61– 76; doi: 10.3390/neurolint12030014.
Nadal-Nicolas Y, Rubio-Arias JA, Martinez-Olcina M, Reche-Garcia C, Hernandez-Garcia M, Martinez-Rodriguez A. Effects of manual therapy on fatigue, pain, and psychological aspects in women with fibromyalgia. Int J Environ Res Public Health. 2020;17(12):4611; doi: 10.3390/ijerph17124611.
Brazoloto TM. Medina Musical interventions and music therapy in pain treatment: literature review. BrJP. 2021;4(4):369–373; doi:10.5935/2595-0118.20210059.
Broetz D, Eichner M, Gasser T, Weller M, Steinbach JP. Radicular and nonradicular back pain in Parkinson’s disease: a controlled study. Mov Disord. 2007;22(6): 853–856; doi: 10.1002/mds.21439.
Ford B. Pain in Parkinson’s disease. Mov Disord. 2010; 25(Suppl 1):98–103. doi: 10.1002/mds.22716.
Watanabe S, Someya F. Effect of body weight-supported walking on exercise capacity and walking speed in patients with knee osteoarthritis: a randomized controlled trial. J Jpn Phys Ther Assoc. 2013;16(1):28–35; doi: 10.1298/jjpta.Vol16_004.
Jaromi M, Nemeth A, Kranicz J, Laczko T, Betlehem J. Treatment and ergonomics training of work-related lower back pain and body posture problems for nurses. J Clin Nurs. 2012; 21(11–12):1776–1784; doi: 10.1111/ j.1365-2702.2012.04089.x.
Sousa, PHC. Effectiveness of the association of acupuncture with exercise on pain, disability and quality of life in individuals with chronic musculoskeletal conditions: systematic review with meta-analysis [in Portuguese]. Dissertation (Master’s degree in Family Health), Fortaleza: College of Pharmacy, Dentistry and Nursing, Federal University of Ceara; 2022. Available from: http://www.repositorio.ufc.br/....
Cosio D, Lin E. Role of active versus passive complementary and integrative health approaches in pain management. Glob Adv Health Med. 2018;7:216495 6118768492; doi: 10.1177/2164956118768492.
Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999;79(2):231–252; doi: 10.1016/s0039-6109 (05)70381-9.
Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7): 798–804; doi: 10.1111/j.1365-2702.2005.01121.x.
Fillingim RB, Loeser JD, Baron R, Edwards RR. Assessment of chronic pain: domains, methods, and mechanisms. J Pain. 2016;17(9):10–20; doi: 10.1016/j.jpain. 2015.08.010.
Chaudhuri KR, Rizos A, Trenkwalder C, Rascol O, Pal S, Martino D, et al. King’s Parkinson’s disease pain scale, the first scale for pain in PD: An international validation. Mov Disord. 2015;30(12):1623–1631; doi: 10.1002/mds.26270.
Scalzo PL, Santos RMS, Carvalho DV, Magalhaes HC, Christo PP, Souza MS, et al. Pain characterization in patients with Parkinson’s disease [in Portuguese]. Rev Bras Neurol. 2018;54(4):78–82.
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