Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews

Abstract

BackgroundChronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%.For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure.ObjectivesTo provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions.MethodsWe searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence.We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death.Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively.Main resultsWe included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.Reviews were well performed an...

Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people

“…Our findings regarding the underlying mechanisms for why pain leads to falls have significant public health implications given the large proportion of older people who report pain and the high cost of fall-related injuries [6]. Relevant strategies for preventing falls in people with knee pain would include treating and managing pain, which may be through appropriate medication prescription, pain management and exercise [39,40]. The role of exercise in this regard may be particularly beneficial as targeted exercise can alleviate pain, reduce body weight as well as improve muscle strength and balance [39,40] two mediators for the relationship between pain and falls identified in our analysis.…”

Predictors of anxiety and depression 2 years following treatment in uveal melanoma survivors

“…One possibility is that symptoms and functional problems cause pain and discomfort that impair daily living over a long time. The adverse effects of chronic pain and discomfort on long-term anxiety and depression are well established 37 and will need to be treated with support and therapeutic programs. 38,39 In terms of clinical implications, the focus of attention during follow-up should be on preparing patients to better understand and cope with symptoms and functional problems.…”

Short‐term swimming exercise attenuates the sensitization of dorsal horn neurons in rats with NGF‐induced low back pain

“…Non-specific low back pain is one of the most common chronic pain conditions (Balagu e et al, 2012), and exercise of the low back has been shown to be an effective physical therapy (Shi et al, 2018). Exercise and other forms of physical therapy are approved therapeutic treatment strategies in the rehabilitation of patients suffering from chronic pain including low back pain (Heneweer et al, 2009;Hooten et al, 2012;Babatunde et al, 2017;Geneen et al, 2017). Physical therapy reduces pain reactions in animals (Cobianchi et al, 2010;Shen et al, 2013;Sluka et al, 2013;Santos et al, 2014;Lima et al, 2017) and pain in humans (Naugle et al, 2012;Babatunde et al, 2017).…”