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

updated Sep 20, 2018

Tags: treatment, exercise, chronic pain, self-treatment, pain problems

PainSci summary of Geneen 2017?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

Chronic pain, exercise, and physical activity are all heavily studied, and yet the surprising result of this massive review of reviews — a super review of twenty-one other reviews, encompassing 381 studies and more than 37,000 participants — somehow amounts to nothing more than “it’s promising, but more study needed.” How can this be? Because most of those 381 studies were individually small and lame, statistically underpowered. Garbage in, garbage out … on a huge scale.

Where there’s smoke there’s probably at least a small fire: “The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life.” But it’s far from the conclusion we’d like to see (even from underpowered studies). Exercise may be “the closest thing there is to a miracle cure” for many other medical problems, but not so much for chronic pain.

Obvious disclaimer: some kinds of pain are undoubtedly more responsive to exercise than others.

original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

AUTHORS' CONCLUSIONS: The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews. There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life.The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period.

original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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