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

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

Four articles on PainSci cite Polaski 2019: 1. The Complete Guide to IT Band Syndrome2. The Complete Guide to Patellofemoral Pain Syndrome3. The Art of Rest4. Repetitive Strain Injuries Tutorial

PainSci notes on Polaski 2019:

This is a good quality review of studies of exercise for chronic pain that tried to extract some wisdom about exercise dosage for chronic pain patients. Unfortunately, it failed: the review establishes only that we know essentially nothing about exercise dosage for chronic pain patients. Our ignorance is near total. There’s just not enough of the right kind of evidence to conclude anything, and almost countless confounding factors and variables that have never been studied.

“The lack of dosing studies for exercise means that patients may not be receiving the optimal therapy and/or be receiving a therapy that actually increases pain.”

From a detailed analysis of the review:

Appropriate exercise dosage may not be generalizable beyond the individual patient given their goals and prior activity levels. … Perhaps it isn’t necessary (or even realistic) to find an optimal, generalizable dosage of exercise for pain states, but rather to find appropriate exercise dosage for the individual based on their desired goals.

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.

OBJECTIVE: Increasing 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.

METHODS: A 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.

RESULTS: Analysis 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.

DISCUSSION: Modest 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.

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