Non-pharmacological interventions may play a greater role in the treatment of patients with Parkinson’s disease

The field of non-pharmacological interventions for the treatment of people with Parkinson’s disease (PD) is rapidly developing and has the potential to significantly improve patient care in the future.

An addition to the Journal of Parkinson’s Disease (JPD) contains a wealth of information on non-pharmacological interventions that address physical and mental perspectives and views on access to care.

The voices of people with Parkinson’s disease are increasingly being heard, leading to a more holistic approach to the treatment of this neurodegenerative disease.

“We are increasingly seeing participatory research approaches, involving patients in designing new treatment programs, preparing consensus statements on the delivery of multidisciplinary care, and in defining outcome measures,” said supplement co-guest editor Elke Kalbe, Ph.D.

Kalbe is affiliated with the Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and the Medical Faculty of the University of Cologne, Cologne, Germany.

“Combined with the empirical observations of clinicians continually confronted with the limitations of pharmacotherapy and the growing body of evidence emerging from adequately designed research studies, these developments provide a much broader perspective on patient care than previously recognized,” adds co-guest editor Bastiaan R. Bloem, MD.

Bloem is from the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Expertise Center Parkinson’s and Movement Disorders, Nijmegen, the Netherlands, and co-editor-in-chief of JPD.

Non-pharmacological interventions for people with PD have traditionally been viewed as supportive measures to primarily alleviate motor symptoms. Although physical therapy, speech therapy and occupational therapy have gradually become integral parts of the overall management of PD, other non-pharmacological interventions such as cognitive training, cognitive behavioural therapy and art or light therapy are only just beginning to be incorporated into therapy guidelines.

Developments highlighted in this supplement include:

• Expansion of the types of interventions
• Standardization of intervention protocols
• Development of digital forms of interventions
• Scientific evaluation of the feasibility and effects of the interventions
• Insight into the underlying mechanisms of therapy-induced plasticity processes
• Integration of non-pharmacological interventions into patient care concepts
• Transition from purely symptomatic to preventive therapies

The field is shifting from addressing motor to non-motor symptoms such as stress. article “Stress Reduction in Parkinson’s Disease: Symptomatic Treatment, Disease Modification, or Both?” reviews the evidence on stress reduction strategies such as exercise and mindfulness-based interventions in Parkinson’s disease, focusing on both symptomatic and disease-modifying effects.

The article highlights the influence of stress and stress reduction on clinical symptoms and pathophysiology of Parkinson’s disease.

“In people with PD, stress is thought to play a particularly important role. Not only does acute stress worsen symptomatic manifestations of the disease, such as tremor, dyskinesia, or freezing of gait, recent evidence in animals also suggests that chronic stress may influence the extent of nigro-striatal cell loss,” said lead author Rick C. Helmich, MD, PhD, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson’s and Movement Disorders, Nijmegen, Netherlands.

The review article “Pain and the Non-Pharmacological Management of Pain in People with Parkinson’s Disease” describes pain and the biopsychosocial model of pain. It examines how pain is classified in PD and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain.

Lead author Natalie Elizabeth Allen, Ph.D., Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia, notes: “This background provides context for a discussion of non-pharmacological pain management strategies that may help manage pain in people with Parkinson’s disease, including exercise, psychological strategies, acupuncture and massage.

“Although there is little PD-specific research to inform the nonpharmacologic management of pain, findings from current PD research are combined with those from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that includes potential biopsychosocial contributors to pain that will then guide a holistic, multimodal approach to management.”

Other articles in the supplement highlight issues surrounding the implementation and provision of adequate access to multidisciplinary care, the optimization of digital health literacy to leverage the benefits of technological approaches, innovative and valid outcome measures to capture subtle changes in symptoms and well-being, and arts-based interventions as emerging therapeutic modalities that may uniquely address aspects of disease that cannot be addressed with conventional treatments.

Co-Guest Editor Lorraine V. Kalia, MD, Ph.D., Krembil Research Institute, Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada, and Co-Editor-in-Chief of JPD“We are seeing clinicians no longer limiting themselves to traditional, non-pharmacological approaches for motor symptoms alone.

“For example, they embrace preventive interventions, such as exercise, but also arts-based interventions, such as dance and visual arts, which have the potential to provide a holistic approach to treating various motor and non-motor symptoms of Parkinson’s disease while improving overall well-being.

“In addition, new approaches are emerging to address cognitive and affective disorders, with technology playing an important role in the delivery and reach of nonpharmacological interventions.”

Co-Guest Editor Alice Nieuwboer, Ph.D., KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium, says: “The scope of non-pharmacological interventions is expanding and healthcare professionals should prioritize these areas in their practice.

“The field of nonpharmacological therapy is clearly reaching clinical and scientific maturity and has the potential to significantly improve patient care in the future.”