Should exercise for chronic musculoskeletal pain be painful?

This systematic review with meta-analysis found that exercising into pain may have a beneficial effect on short-term patient-reported pain levels. No differences were found on the medium-and long-term. Overall quality of evidence ranged from moderate to low.

Chronic musculoskeletal pain is one of the leading causes of disability worldwide. It has been shown that pain-related beliefs and behaviors such as fear avoidance, catastrophizing and kinesiophobia play an important role in chronic musculoskeletal pain. Given the low correlation between pain and tissue damage, it has been proposed that exercising into pain could address these psychological factors and have a desensitizing effect. However, no systematic reviews have addressed the effectiveness of exercising into pain in chronic musculoskeletal pain.

This review included 9 trials. Patient-reported levels of pain were taken at various follow-up periods and classified as short-term (≤3 months), medium-term (>3 and

Painful exercise was shown to have greater benefits for patient-reported outcomes on the short-term, with a small effect size and from low quality evidence. No differences were found in the medium- and long-term, also resulting from low quality evidence. Despite the review’s limitations, results show pain need not be a limiting factor in exercise interventions and exercising into pain may address pain-related psychological factors and expose patients to increased loads, which can induce greater adaptations in the musculoskeletal system.

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> From: Smith, Br J Sports Med (2017) (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.