Neuropathic pain thought to arise from abnormal firing in afferent nerve fibers within dystonic muscles. May include paresthesia, burning dysthesia, coldness, numbness, and deep aching (68).
Location of Pain
Many pain problems occur only in the 'off' state. Legs and feet are more often involved than arms with face and neck being least commonly affected. Pain is often more severe on side of body on which PD symptoms are worst (68).
Aggravating Factors
N/A
Alleviating Factors and Treatment Options
N/A
Specific Exercise Guidelines to Manage Pain
Little has been studied or noted in regard to exercise and neuropathic pain relief in PD.
Most commonly described as dull, tingling, aching, cramp sensation, stiffness, and muscle tension (72).
Location of Pain
Lower part of back/trunk and lower extremities (72).
Aggravating Factors
Fatigue (68).
Sleep disturbances (72).
Lower levels of education (72).
Alleviating Factors and Treatment Options
Pharmacological
Pain often responds to adjustment of antiparkinsonian medications, especially dopamine agonists (68).
Non-Pharmacological
Education given in selective amounts depending on stage of disease. Initially don't want to provide too much information as to cause alarm or anxiety but enough to give sense of control (68).
Social support - initially support groups with one-on-one peer support or groups with newly diagnosed people with PD can be more helpful (68).
Employment, even if modifications are needed such as changes in job requirements, fewer hours or workplace environment changes (68).
Physiotherapy (72).
Massage (72).
Specific Exercise Guidelines to Manage Pain
Although not specifically shown to reduce pain, the following general guidelines appear not to aggravate pain while increasing mobility and mood:
Include aerobic, strengthening and stretching activities (68).
Aerobic exercise intensity should be 60%-70% of maximum heart rate (68).
Non-weight bearing aerobic exercises may be especially beneficial although few studies exist to confirm this (68).
Consider warm water aerobics. It may reduce rigidity and provide additional sensory cues to help control movements (75).
Strengthening exercise should use lightweight with the goal to improve flexibility and strength but not to add bulk. Emphasize extensor muscles to counteract the flexor postures common with PD (68).
Stretching should be performed when muscles are warm (68).
To minimize impact of fatigue, it may be helpful to learn energy conservation techniques from physical therapist (68).
Identify any comorbidities or limitations such as reduced range of motion to minimize risk of injury (68).
Treadmill training with body weight support may be more effective in improving short-term mobility of people with PD than physical therapy. More study is needed (61).
Consider music therapy to help bradykinesia and rigidity by providing external rhythmic cues that may stimulate different sensory pathways and enhance mood (69,75).
