Exercise-induced hypoalgesia is present in people with Parkinson’s disease: Two observational cross-sectional studies
Vanessa Nguy
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
Search for more papers by this authorBenjamin K. Barry
School of Medical Sciences, University of New South Wales, Sydney, Australia
Neuroscience Research Australia, Sydney, Australia
School of Clinical Medicine, The University of Queensland, Brisbane, Australia
Search for more papers by this authorNiamh Moloney
Department of Health Sciences, Macquarie University, Sydney, Australia
Search for more papers by this authorLeanne M. Hassett
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
School of Public Health, The University of Sydney, Sydney, Australia
Search for more papers by this authorColleen G. Canning
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
Search for more papers by this authorSimon J. G. Lewis
The Brain and Mind Centre, The University of Sydney, Sydney, Australia
Search for more papers by this authorCorresponding Author
Natalie E. Allen
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
Correspondence
Natalie E. Allen, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, Australia, 1825.
Email: [email protected]
Search for more papers by this authorVanessa Nguy
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
Search for more papers by this authorBenjamin K. Barry
School of Medical Sciences, University of New South Wales, Sydney, Australia
Neuroscience Research Australia, Sydney, Australia
School of Clinical Medicine, The University of Queensland, Brisbane, Australia
Search for more papers by this authorNiamh Moloney
Department of Health Sciences, Macquarie University, Sydney, Australia
Search for more papers by this authorLeanne M. Hassett
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
School of Public Health, The University of Sydney, Sydney, Australia
Search for more papers by this authorColleen G. Canning
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
Search for more papers by this authorSimon J. G. Lewis
The Brain and Mind Centre, The University of Sydney, Sydney, Australia
Search for more papers by this authorCorresponding Author
Natalie E. Allen
Faculty of Health Sciences, The University of Sydney, Sydney, Australia
Correspondence
Natalie E. Allen, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, Australia, 1825.
Email: [email protected]
Search for more papers by this authorFunding information
Parkinson’s NSW Bendigo Bank Parkinson’s Research Grant.
Abstract
Background
Exercise is prescribed for people with Parkinson’s disease to address motor and non-motor impairments, including pain. Exercise-induced hypoalgesia (i.e., an immediate reduction in pain sensitivity following exercise) is reported in the general population; however, the immediate response of pain sensitivity to exercise in people with Parkinson’s disease is unknown. The purpose of this study was to investigate if exercise-induced hypoalgesia is present following isometric and aerobic exercise in people with Parkinson’s disease, and if so, if it varies with the dose of aerobic exercise.
Methods
Thirty people with idiopathic Parkinson’s disease and pain-free age-matched controls completed two observational studies evaluating the response to: (a) right arm isometric exercise; and (b) treadmill walking at low and moderate intensities. Pressure pain thresholds were measured over biceps brachii and quadriceps muscles immediately before and after exercise, with increased thresholds after exercise indicating exercise-induced hypoalgesia.
Results
Pressure pain thresholds increased in the Parkinson’s disease group at all tested sites following all exercise bouts (e.g., isometric exercise, right bicep 29%; aerobic exercise, quadriceps, moderate intensity 8.9%, low intensity 7.1% (p ≤ 0.008)), with no effect of aerobic exercise dose (p = 0.159). Similar results were found in the control group.
Conclusions
Overall, people with Parkinson’s disease experienced an exercise-induced hypoalgesia response similar to that of the control group, the extent of which did not vary between mild and moderate doses of aerobic exercise. Further research is warranted to investigate potential longer term benefits from exercise in the management of pain in this population.
Significance
Isometric and aerobic exercise reduces pain sensitivity in people with Parkinson’s disease. As exercise is important for people with Parkinson’s disease, these results provide assurance that people with Parkinson’s disease and pain can exercise without an immediate increase in pain sensitivity. The reduction in pain sensitivity with both modes and with low and moderate intensities of aerobic exercise suggests that people with Parkinson’s disease can safely choose the mode and intensity of exercise that best suits their needs.
CONFLICT OF INTEREST
None declared.
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REFERENCES
- Allen, N. E., Moloney, N., van Vliet, V., & Canning, C. G. (2015). The rationale for exercise in the management of pain in Parkinson’s disease. Journal of Parkinson’s Disease, 5, 229–239.
- Allen, N. E., Wong, C. M., Canning, C. G., & Moloney, N. (2016). The association between Parkinson’s disease motor impairments and pain. Pain Medicine, 17, 456–462.
- Anshel, M., & Russell K. G. (1994). Effect of aerobic and strength training on pain tolerance, pain appraisal and mood of unfit males as a function of pain location. Journal of Sports Sciences, 12, 535–547.
- Beiske, A. G., Loge, J. H., Ronningen, A., & Svensson, E. (2009). Pain in Parkinson’s disease: Prevalence and characteristics. Pain, 141, 173–177.
- Borg, G. (1998). Borg's perceived exertion and pain scales. Champaign, IL: Human Kinetics.
- Braak, H., Del Tredici, K., Rüb, U., De Vos, R. A. I., Jansen Steur, E. N. H., & Braak, E. (2003). Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiology of Aging, 24, 197–211.
- Broen, M. P., Braaksma, M. M., Patijn, J., & Weber, W. E. (2012). Prevalence of pain in Parkinson’s disease: A systematic review using the modified QUADAS tool. Movement Disorders, 27, 480–484.
- Burrows, N. J., Booth, J., Sturnieks, D. L., & Barry, B. K. (2014). Acute resistance exercise and pressure pain sensitivity in knee osteoarthritis: A randomised crossover trial. Osteoarthritis Cartilage, 22, 407–414.
- Chaudhuri, K. R., Rizos, A., Trenkwalder, C., Rascol, O., Pal, S., Martino, D., … Europar, the INMPDSG. (2015). King's Parkinson’s disease pain scale, the first scale for pain in PD: An international validation. Movement Disorders, 30, 1623–1631.
- de Souza, G. G., Duarte, I. D., & de Castro, Perez A. (2013). Differential involvement of central and peripheral α2 adrenoreceptors in the antinociception induced by aerobic and resistance exercise. Anesthesia & Analgesia, 116, 703–711.
- Defazio, G., Berardelli, A., Fabbrini, G., Martino, D., Fincati, E., Fiaschi, A., … Tinazzi, M. (2008). Pain as a nonmotor symptom of Parkinson disease: Evidence from a case-control study. Archives of Neurology, 65, 1191–1194.
- Del Sorbo, F., & Albanese, A. (2012). Clinical management of pain and fatigue in Parkinson’s disease. Parkinsonism & Related Disorders, 18, S233–S236.
- Ellingson, L. D., Colbert, L. H., & Cook, D. B. (2012). Physical activity is related to pain sensitivity in healthy women. Medicine and Science in Sports and Exercise, 44, 1401–1406.
- Ford, B. (2009). Parkinson disease Pain in Parkinson disease: The hidden epidemic. Nature Reviews Neurology, 5, 242–243.
- Galdino, G. S., Duarte, I. D., & Perez, A. C. (2015). Central release of nitric oxide mediates antinociception induced by aerobic exercise. Brazilian Journal of Medical and Biological Research, 48, 790–797.
- Goetz, C. G., Tilley, B. C., Shaftman, S. R., Stebbins, G. T., Fahn, S., Martinez-Martin, P. …, & Movement Disorder Society URTF. (2008). Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Movement Disorders, 23, 2129–2170.
- Gurevich, M., Kohn, P. M., & Davis, C. (1994). Exercise-induced analgesia and the role of reactivity in pain sensitivity. Journal of Sports Sciences, 12, 549–559.
- Hoeger Bement, M. K., Dicapo, J., Rasiarmos, R., & Hunter, S. K. (2008). Dose response of isometric contractions on pain perception in healthy adults. Medicine and Science in Sports and Exercise, 40, 1880–1889.
- Hoffman, M. D., Shepanski, M. A., Mackenzie, S. P., & Clifford, P. S. (2005). Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain. Journal of Rehabilitation Research and Development, 42, 183–190.
- Hoffman, M. D., Shepanski, M. A., Ruble, S. B., Valic, Z., Buckwalter, J. B., & Clifford, P. S. (2004). Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain. Archives of Physical Medicine and Rehabilitation, 85, 1183–1187.
- Holden, J. E., Jeong, Y., & Forrest, J. M. (2005). The endogenous opioid system and clinical pain management. AACN Clinical Issues, 16, 291–301.
- Hübscher, M., Moloney, N., Rebbeck, T., Traeger, A., & Refshauge, K. M. (2014). Contributions of mood, pain catastrophizing, and cold hyperalgesia in acute and chronic low back pain: A comparison with pain-free controls. The Clinical Journal of Pain, 30, 886–893.
- International Association for the Study of Pain. (2018). IASP Terminology—IASP. Retrieved from https://www.iasp-pain.org/terminology?navItemNumber=576#Sensitization
- Jellinger, K. A. (1991). Pathology of Parkinson’s disease. Molecular and Chemical Neuropathology, 14, 153–197.
- Jones, M. D., Booth, J., Taylor, J. L., & Barry, B. K. (2014). Aerobic training increases pain tolerance in healthy individuals. Medicine and Science in Sports and Exercise, 46, 1640–1647.
- Jones, M. D., Taylor, J. L., & Barry, B. K. (2017). Occlusion of blood flow attenuates exercise-induced hypoalgesia in the occluded limb of healthy adults. Journal of Applied Physiology, 122, 1284–1291.
- Jones, M. D., Valenzuela, T., Booth, J., Taylor, J. L., & Barry, B. K. (2017). Explicit education about exercise-induced hypoalgesia influences pain responses to acute exercise in healthy adults: A randomized controlled trial. The Journal of Pain, 18, 1409–1416.
- Kadetoff, D., & Kosek, E. (2007). The effects of static muscular contraction on blood pressure, heart rate, pain ratings and pressure pain thresholds in healthy individuals and patients with fibromyalgia. European Journal of Pain (London, England), 11, 39–47.
- Keller, S., Bann, C. M., Dodd, S. L., Schein, J., Mendoza, T. R., & Cleeland, C. S. (2004). Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. The Clinical Journal of Pain, 20, 309–318.
- Koltyn, K. F. (2002). Exercise-induced hypoalgesia and intensity of exercise. Sports Medicine, 32, 477–487.
- Koltyn, K. F., Brellenthin, A. G., Cook, D. B., Sehgal, N., & Hillard, C. (2014). Mechanisms of exercise-induced hypoalgesia. The Journal of Pain, 15, 1294–1304.
- Koltyn, K. F., Garvin, A. W., Gardiner, R. L., & Nelson, T. F. (1996). Perception of pain following aerobic exercise. Medicine and Science in Sports and Exercise, 28, 1418–1421.
- Koltyn, K. F., Trine, M. R., Stegner, A. J., & Tobar, D. A. (2001). Effect of isometric exercise on pain perception and blood pressure in men and women. Medicine and Science in Sports and Exercise, 33, 282–290.
- Koltyn, K. F., & Umeda, M. (2007). Contralateral attenuation of pain after short-duration submaximal isometric exercise. The Journal of Pain, 8, 887–892.
- Lannersten, L., & Kosek, E. (2010). Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain, 151, 77–86.
- Mayer, T. G., Neblett, R., Cohen, H., Howard, K. J., Choi, Y. H., Williams, M. J., … Gatchel, R. J. (2012). The development and psychometric validation of the central sensitization inventory. Pain Practice: The Official Journal of World Institute of Pain, 12, 276–285.
- Meeus, M., Roussel, N. A., Truijen, S., & Nijs, J. (2010). Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: An experimental study. Journal of Rehabilitation Medicine, 42, 884–890.
- Naugle, K. M., Fillingim, R. B., & Riley, J. L., 3rd. (2012). A meta-analytic review of the hypoalgesic effects of exercise. J Pain, 13, 1139–1150.
- Naugle, K. M., Naugle, K. E., & Riley, J. L., 3rd. (2016). Reduced modulation of pain in older adults after isometric and aerobic exercise. The Journal of Pain, 17, 719–728.
- Naugle, K. M., & Riley, J. L., 3rd. (2014). Self-reported physical activity predicts pain inhibitory and facilitatory function. Medicine and Science in Sports and Exercise, 46, 622–629.
- Negre-Pages, L., Regragui, W., Bouhassira, D., Grandjean, H., Rascol, O., & DoPaMi, P. S. G. (2008). Chronic pain in Parkinson’s disease: The cross-sectional French DoPaMiP survey. Movement Disorders, 23, 1361–1369.
- Newcomb, L. W., Koltyn, K. F., Morgan, W. P., & Cook, D. B. (2011). Influence of preferred versus prescribed exercise on pain in fibromyalgia. Medicine and Science in Sports and Exercise, 43, 1106–1113.
- Perez de la Cruz, S. (2017). Effectiveness of aquatic therapy for the control of pain and increased functionality in people with Parkinson’s disease: A randomized clinical trial. European Journal of Physical and Rehabilitation Medicine, 53, 825–832.
- Quittenbaum, B. H., & Grahn, B. (2004). Quality of life and pain in Parkinson’s disease: A controlled cross-sectional study. Parkinsonism & Related Disorders, 10, 129–136.
- Reuter, I., Mehnert, S., Leone, P., Kaps, M., Oechsner, M., & Engelhardt, M. (2011). Effects of a flexibility and relaxation programme, walking, and nordic walking on Parkinson’s disease. Journal of Aging Research, 2011, 1329–18.
10.4061/2011/232473 Google Scholar
- Ridgel, A. L., Vitek, J. L., & Alberts, J. L. (2009). Forced, not voluntary, exercise improves motor function in Parkinson’s disease patients. Neurorehabilitation and Neural Repair, 23, 600–608.
- Rolinski, M., Szewczyk-Krolikowski, K., Tomlinson, P. R., Nithi, K., Talbot, K., Ben-Shlomo, Y., & Hu, M. T. (2014). REM sleep behaviour disorder is associated with worse quality of life and other non-motor features in early Parkinson’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 85, 560–566.
- Schenkman, M., Moore, C. G., Kohrt, W. M., Hall, D. A., Delitto, A., Comella, C. L., … Corcos, D. M. (2018). Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: A phase 2 randomized clinical trial. JAMA Neurology, 75, 219–226.
- Scherder, E. J. A., Wolters, E. C. M. J., Polman, C. H., Sergeant, J. A., & Swaab, D. F. (2005). Pain in Parkinson’s disease and multiple sclerosis: Its relation to the medial and lateral pain systems. Neuroscience and Biobehavioral Reviews, 29, 1047–1056.
- Shen, X., Wong-Yu, I. S. K., & Mak, M. K. Y. (2016). Effects of exercise on falls, balance, and gait ability in Parkinson’s disease: A meta-analysis. Neurorehabilitation and Neural Repair, 30, 512–527.
- Sophie, M., & Ford, B. (2012). Management of pain in Parkinson's disease. CNS Drugs, 26, 937–948.
- Sparling, P. B., Giuffrida, A., Piomelli, D., Rosskopf, L., & Dietrich, A. (2003). Exercise activates the endocannabinoid system. NeuroReport, 14, 2209–2211.
- Stagg, N. J., Mata, H. P., Ibrahim, M. M., Henriksen, E. J., Porreca, F., Vanderah, T. W., & Malan, T. P. (2011). Regular exercise reverses sensory hypersensitivity in a rat neuropathic pain model role of endogenous opioids. Anesthesiology, 114, 940–948.
- Staud, R., Robinson, M. E., & Price, D. D. (2005). Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls. Pain, 118, 176–184.
- Sung, S., Vijiaratnam, N., Chan, D. W., Farrell, M., & Evans, A. H. (2018). Pain sensitivity in Parkinson's disease: Systematic review and meta-analysis. Parkinsonism & Related Disorders, 48, 17–27.
- Tomlinson, C. L., Patel, S., Meek, C., Herd, C. P., Clarke, C. E., Stowe, R., … Ives, N. (2012). Physiotherapy intervention in Parkinson’s disease: Systematic review and meta-analysis. BMJ, 345, e5004.
- Umeda, M., Lee, W., Marino, C. A., & Hilliard, S. C. (2016). Influence of moderate intensity physical activity levels and gender on conditioned pain modulation. Journal of Sports Sciences, 34, 467–476.
- Umeda, M., Newcomb, L. W., Ellingson, L. D., & Koltyn, K. F. (2010). Examination of the dose-response relationship between pain perception and blood pressure elevations induced by isometric exercise in men and women. Biological Psychology, 85, 90–96.
- Vaegter, H. B., Handberg, G., Emmeluth, C., & Graven-Nielsen, T. (2017). Preoperative hypoalgesia after cold pressor test and aerobic exercise is associated with pain relief 6 months after total knee replacement. Clinical Journal of Pain, 33, 475–484.
- Valkovic, P., Minar, M., Singliarova, H., Harsany, J., Hanakova, M., Martinkova, J., Benetin, J., & LeDoux, M. S. (2015). Pain in Parkinson’s disease: A cross-sectional study of its prevalence, types, and relationship to depression and quality of life. PLoS ONE, 10, e0136541.
- Vierck, C. J., Jr, Staud, R., Price, D. D., Cannon, R. L., Mauderli, A. P., & Martin, A. D. (2001). The effect of maximal exercise on temporal summation of second pain (windup) in patients with fibromyalgia syndrome. The Journal of Pain, 2, 334–344.
- Yarnitsky, D. (2010). Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): Its relevance for acute and chronic pain states. Current Opinion in Anaesthesiology, 23, 611–615.
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