The balancing exercise of exercise prescription in chronic pain?   January 1st, 2015

In a very recent review and clinical guideline of Heather Kroll, a nice overview is given about how exercise affects pain. But besides listing possible mechanisms of exercise induced analgesia, she reviews the therapeutic modalities and benefits for a wide variety of chronic pain diagnoses. Finally the most interesting for clinicians are the guidelines for a thorough biopsychosocial assessment before exercise prescription and the specific strategies for exercise programs depending on the individual patient profile. The review really fits in our understanding of chronic pain and exercise, as discussed several times before on our website, on blogs and on congresses

Key points of the paper are:

  • Exercise has been demonstrated in animal and human studies to diminish pain experience by its effect on the endogenous pain modulatory systems.
  • Exercise, in general, is therapeutic for a wide variety of chronic pain diagnoses, but it has been difficult to show that one particular approach is superior to another.
  • Patients have multiple barriers to successfully participating in exercise including patient specific factors, environmental factors, and health care delivery factors.
  • Evaluation of a patient before exercise prescription should include a comprehensive biopsychosocial assessment and determination of the goals of the exercise program.
  • Successful exercise prescription requires coordination of care and good communication between physician, therapist, and patient.
  • Successful exercise prescription requires patient education regarding the impact of exercise on the nervous system, education targeting fear-avoidance beliefs, and education about the details of how to do the exercise program.

Mira Meeus 

2015 Pain in Motion

References and further reading

Kroll HR. Exercise therapy for chronic pain. Phys Med Rehabil Clin N Am. 2015 May;26(2):263-81. doi: 10.1016/j.pmr.2014.12.007. Epub 2015 Feb 21.