WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
reported the effect of exercise on pain in PD were identified, though pain was not the focus of the intervention in either trial. One reported a trend towards a reduction in pain, and the other reported a reduction in the presence and intensity of pain following exercise. However, these results do not indicate if exercise targets particular subtypes of pain. Conclusion(s): The neurophysiological effects of exercise such as neuroplasticity, neuro-restoration and activation of dopaminergic and non-dopaminergic pain inhibition provide a sound biological rationale for employing exercise in pain management. However, randomised controlled trials of exercise interventions for people with PD are required to determine if exercise results in a clinical reduction in pain in this population. Implications: Therapists should consider assessing people with PD for pain and monitoring any changes in pain in response to exercise interventions. Keywords: Parkinson’s disease; Pain; Exercise Funding acknowledgements: No funding was received for this project. Ethics approval: Ethics approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.174 Research Report Platform Presentation Number: RR-PL-2404 Sunday 3 May 2015 08:30 Room 303–304 RIGIDITY BUT NOT TREMOR IS ASSOCIATED WITH PAIN IN PEOPLE WITH PARKINSON’S DISEASE N.E. Allen 1 , N. Moloney 2 , C. Wong 3 , C.G. Canning 1 1 The
University of Sydney, Clinical and Rehabilitation Sciences Research Group, Sydney, Australia; 2 The University of Sydney, Arthritis and Musculoskeletal Disorders Research Group, Sydney, Australia; 3 The University of Sydney, Discipline of Physiotherapy, Sydney, Australia Background: Up to 85% of people with Parkinson’s disease (PD) experience pain. Previous research has explored the presence and severity of pain in PD, but not the frequency of pain or the effect that pain has on activities. Additionally, the pathophysiology of pain in people with PD is complex, and the contributions of impairments to pain are poorly understood. Purpose: This study aimed to: (1) explore the severity and frequency of pain and the extent to which pain interferes with everyday work in people with PD; and (2) explore the potential contributions of PD motor impairments to measures of pain.
Methods: This cross sectional study utilised baseline data from a randomised controlled trial with 231 participants (135 male) with mild to moderate PD. Three measures of pain were used: pain severity (question 21 of the SF-36TM ); the extent to which pain interfered with normal work (including work outside the home and housework) (question 5 of the SF-12v2TM ); and pain frequency in the past month (the sum of questions 37–39 from the Parkinson’s Disease Questionnaire). The Unified Parkinson’s Disease Rating Scale was used to measure bradykinesia, rigidity, tremor, dyskinesias and motor fluctuations. Freezing of gait was determined as the presence or absence of freezing in the past month. Descriptive statistics were used to report the prevalence of each of the three pain outcomes. The pain outcome measures were dichotomised to allow associations between impairments and pain to be explored using univariate and multivariate logistic regression, with the multivariate models adjusted for age and gender. Results: Some bodily pain was reported by 187 (81%) of participants, with 91 (39%) reporting this pain to be of moderate severity or worse. Muscle spasms or cramps occurred at least occasionally in 168 (73%) participants; aches and pains in 193 (83%), and unpleasant heat or cold sensations in 159 (69%). Pain interfered with work to some extent in 158 (68%) of participants. Univariate logistic regression showed that none of the included impairments were associated with more severe pain. In contrast, all impairments, except tremor, were associated with more frequent pain. Greater disease severity, bradykinesia, rigidity and dyskinesias were associated with more pain that interfered with work. Multivariate models showed that rigidity was the only impairment to remain associated with frequent pain and pain that interfered with work (for both models, Odds Ratio = 1.14, 95% confidence interval 1.0–1.3, p ≤ 0.05). Conclusion(s): Most people with PD experience pain which occurs at least monthly, and interferes with daily activities. PD impairments are associated with more frequent pain and with more pain that interferes with work, with rigidity having the strongest association. Implications: Physical therapy for people with PD should include assessment and management of pain. The finding that rigidity is associated with pain, while tremor is not, suggests that pain profiles may vary according to subtypes of PD and this possibility requires further investigation. Keywords: Parkinson’s disease; Pain; Impairments Funding acknowledgements: Australian National Health and Medical Research Council and the Harry Secomb Foundation. Ethics approval: Ethical approval obtained from The University of Sydney Human Research Ethics Committee. http://dx.doi.org/10.1016/j.physio.2015.03.175