Exercise Not a Panacea for Chronic Pain

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. – PubMed – Cochrane Database Syst Rev. 2017 Jan

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.

So all this exercise and activity has been pushed on pain patients, but no one has done studies to show that the blanket recommendation to exercise has been beneficial?

For pain patients, this is unusually important because doing the exercise itself can cause a large increase in pain.

Our hope is that the momentary pain is less than the potential long-term pain from letting ourselves get out of shape and, in the case of EDS, no longer able to hold our joints stable.

We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs),

So, this is a review of other reviews?

METHODS:

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.

We 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

Interventions included

  • aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as
  • yoga,
  • Pilates, and
  • tai chi.
  • However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months).

Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention

However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point.

Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes).

Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups.

Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant.

Based on the available evidence, most adverse events were increased soreness or muscle pain, which reportedly subsided after a few weeks of the intervention.

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

AUTHORS’ CONCLUSIONS:

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

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.

There were variable effects for psychological function and quality of life.

 

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