The Rationale for Exercise in the Management of Pain in Parkinson's Disease.
The Rationale for Exercise in the Management of Pain in Parkinson's Disease.
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DOI：
10.3233/jpd-140508
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Canning CG
中科院分区：
文献类型：
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作者：
Allen NE;Moloney N;van Vliet V;Canning CG
疼痛是一种令人痛苦的非运动症状，高达85%的帕金森病（PD）患者会经历这种症状，但通常未经治疗。这种疼痛可能受到许多因素的影响，包括疾病过程、PD损伤以及共存的肌肉骨骼和/或神经性疼痛状况。专家建议将运动作为疼痛管理计划的一个组成部分;然而，运动对这一人群疼痛的影响尚不清楚。本文综述了运动对帕金森病疼痛相关病理生理过程的潜在影响。来自动物和人类研究的新证据表明，运动可能有助于神经可塑性和神经恢复，通过增加脑神经营养因子，突触强度和血管生成，以及刺激神经发生和改善代谢和免疫反应。这些变化可能有助于改善疼痛的中枢处理。还有证据表明，运动可以激活多巴胺能和非多巴胺能疼痛抑制通路，这表明运动可能有助于调节PD患者的疼痛体验。虽然运动对PD患者疼痛缓解效果的临床数据很少，而且迫切需要，但提出了运动处方的初步指南，用于PD患者中枢神经性、外周神经性和肌肉骨骼疼痛的管理。
Pain is a distressing non-motor symptom experienced by up to 85% of people with Parkinson’s disease (PD), yet it is often untreated. This pain is likely to be influenced by many factors, including the disease process, PD impairments as well as co-existing musculoskeletal and/or neuropathic pain conditions. Expert opinion recommends that exercise is included as one component of pain management programs; however, the effect of exercise on pain in this population is unclear. This review presents evidence describing the potential influence of exercise on the pain-related pathophysiological processes present in PD. Emerging evidence from both animal and human studies suggests that exercise might contribute to neuroplasticity and neuro-restoration by increasing brain neurotrophic factors, synaptic strength and angiogenesis, as well as stimulating neurogenesis and improving metabolism and the immune response. These changes may be beneficial in improving the central processing of pain. There is also evidence that exercise can activate both the dopaminergic and non-dopaminergic pain inhibitory pathways, suggesting that exercise may help to modulate the experience of pain in PD. Whilst clinical data on the effects of exercise for pain relief in people with PD are scarce, and are urgently needed, preliminary guidelines are presented for exercise prescription for the management of central neuropathic, peripheral neuropathic and musculoskeletal pain in PD.