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

Anna M Polaski, Amy L Phelps, Matthew C Kostek, Kimberly A Szucs, Benedict J Kolber, Anna M Polaski, Amy L Phelps, Matthew C Kostek, Kimberly A Szucs, Benedict J Kolber

Abstract

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart diagram showing reference…
Fig 1. Flow chart diagram showing reference screening and study selection based on exclusion and inclusion criteria.
Fig 2. ‘Risk of bias’ graph: Review…
Fig 2. ‘Risk of bias’ graph: Review authors’ assessments for each risk of bias item presented as percentages across all included studies.
Fig 3. Pain effect size vs. DURATION…
Fig 3. Pain effect size vs. DURATION of exercise for neck pain patients for all exercise modalities.
DURATION of intervention is measured in weeks, n = 8, shows a statistically significant positive correlation with analgesic effect (p = 0.0059). R represents Pearson’s correlation coefficient. Dotted line represents line of best fit.

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