Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain

Abstract

ObjectiveIncreasing evidence purports exercise as a first-line therapeutic for the treatment of nearly all forms of chronic pain. However, knowledge of efficacious dosing respective to treatment modality and pain condition is virtually absent in the literature. The purpose of this analysis was to calculate the extent to which exercise treatment shows dose-dependent effects similar to what is seen with pharmacological treatments.MethodsA recently published comprehensive review of exercise and physical activity for chronic pain in adults was identified in May 2017. This report reviewed different physical activity and exercise interventions and their effectiveness in reducing pain severity and found overall modest effects of exercise in the treatment of pain. We analyzed this existing data set, focusing specifically on the dose of exercise intervention in these studies. We re-analyzed data from 75 studies looking at benefits of time of exercising per week, frequency of exercise per week, duration of intervention (in weeks), and estimated intensity of exercise.ResultsAnalysis revealed a significant positive correlation with exercise duration and analgesic effect on neck pain. Multiple linear regression modeling of these data predicted that increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients.DiscussionModest effects were observed with one significant correlation between duration and pain effect for neck pain. Overall, these results provide insufficient evidence to conclude the presence of a strong dose effect of exercise in pain, but our modeling data provide tes predictions that can be used to design future studies to explicitly test the question of dose in specific patient populations.

Longitudinal associations of changes in physical activity and TV viewing with chronic musculoskeletal pain in Brazilian schoolteachers

“…In a cross-sectional study with teachers from Ethiopia, the practice of physical activity was also associated with the reduction of chronic low back pain [25]. Moreover, this was also observed in a meta-analysis performed with studies about physical activity, exercise and pain that showed that increasing weekly physical activity decreased the symptoms of chronic pain [13], including persistent pain in the low back region https://doi.org/10.1371/journal.pone.0234609.t001 Table 2. Association between change in leisure-time physical activity behavior and TV viewing (independent variables) and chronic musculoskeletal pain (dependent variable) after 24 months in schoolteachers, Londrina/PR, Brazil, 2012-2014.…”

“…Longitudinal studies based on objective measures, intensity and other domains of physical activity are still needed to examine a possible dose-response effect. Although our results come from a study with a longitudinal observational design, they are in the same direction as experimental [13] studies that provide relevant evidence that the encouragement to walk or cycle to and from work and the implementation of physical activity promotion in the work environment can play a relevant role in workers' health and quality of life. Together with an adequate supply of health services for the diagnosis, treatment and control of painful conditions, the promotion of physical activity among schoolteachers is a strategy with the potential to contribute to the reduction of absenteeism and presenteeism resulting from CMP, benefiting not only the worker but also the educational system.…”

“…In a recent meta-analysis of prospective studies, the practice of leisure-time physical activity (LTPA) was associated with a 16.0% reduction in the risk of chronic low back pain when comparing individuals with regular physical activity (3 to 4 times a week, totaling between 2 and 4 hours per week) with individuals who did not practice physical activity regularly [12]. Another meta-analysis of studies with adults indicated that increasing weekly physical activity frequency has a chronic pain reduction effect, although the authors concluded that available evidence is not sufficient to identify dose effects of physical activity in relation to analgesia [13]. In addition, there is evidence that reducing sitting time during the day may also lead to beneficial effects on chronic pain control in specific regions, such as the lower back [14].…”

Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

“…Exercise is known to decrease sensitivity to pain, an endogenous form of pain modulation termed 'exerciseinduced hypoalgesia' (EIH) [1]. In the exercising muscle, EIH is reported following acute bouts of resistance [2], aerobic [3] and isometric exercise [4,5], with several review articles summarising this research [1,[6][7][8][9].…”

Integrated meditation and exercise therapy: A randomized controlled trial of a combined non-pharmacological intervention reduces disability and pain in patients with chronic low back pain

“…In our previous work, we have elucidated that increasing the frequency component of exercise dose to be the most likely to have a positive effect on chronic pain patients [43]. We tested these predictions in a trial with multiple doses of moderate intensity treadmill walking exercise in healthy subjects.…”