Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review

Abstract

Background Pain sensitisation plays a major role in musculoskeletal pain. However, effective treatments are limited, and although there is growing evidence that exercise may improve pain sensitisation, the amount and type of exercise remains unclear. This systematic review examines the evidence for an effect of aerobic exercise on pain sensitisation in musculoskeletal conditions. Methods Systematic searches of six electronic databases were conducted. Studies were included if they examined the relationship between aerobic physical activity and pain sensitisation in individuals with chronic musculoskeletal pain, but excluding specific patient subgroups such as fibromyalgia. Risk of bias was assessed using Cochrane methods and a qualitative analysis was conducted. Results Eleven studies (seven repeated measures studies and four clinical trials) of 590 participants were included. Eight studies had low to moderate risk of bias. All 11 studies found that aerobic exercise increased pressure pain thresholds or decreased pain ratings in those with musculoskeletal pain [median (minimum, maximum) improvement in pain sensitisation: 10.6% (2.2%, 24.1%)]. In these studies, the aerobic exercise involved walking or cycling, performed at a submaximal intensity but with incremental increases, for a 4-60 min duration. Improvement in pain sensitisation occurred after one session in the observational studies and after 2-12 weeks in the clinical trials. Conclusions These findings provide evidence that aerobic exercise reduces pain sensitisation in individuals with musculoskeletal pain. Further work is needed to determine whether this translates to improved patient outcomes, including reduced disability and greater quality of life.

Accumulation of long‐term diseases is associated with musculoskeletal pain dimensions among middle‐aged individuals with musculoskeletal pain

“…stroke) abovementioned distress (Hiles et al, 2017). These factors may mediate the relationship between long-term diseases and pain dimensions, as they likely have an effect on pain sensitivity (Sivertsen et al, 2015;Tan et al, 2022). On the other hand, persistent MSK diseases are often present in the multimorbidity patterns (Prados-Torres et al, 2014), which may be perceived as the association between accumulated long-term diseases and pain dimensions in the present design.…”

“…Previous studies have recognized a number of determinants, apart from long-term diseases, which are implicated in pain dimensions or pain experience in general, including sociodemographic (Hartvigsen et al, 2018;Mansfield et al, 2016;Neupane et al, 2020), psychological (Aili et al, 2021;Hartvigsen et al, 2018;Martinez-Calderon et al, 2018;Neupane et al, 2020), occupational (Hartvigsen et al, 2018;Oakman et al, 2017) and lifestyle (Aili et al, 2021;Hartvigsen et al, 2018;Neupane et al, 2020;Sivertsen et al, 2015;Tan et al, 2022) factors. Some of these factors may also explain our results.…”

Community-based non-pharmacological interventions for improving pain, disability, and quality of life in pregnant women with musculoskeletal conditions: a systematic review

“…However, this latter result was found in experimentally induced pain, and it is unclear to what extent the sample mirrors people with clinical pain. In a clinical population with musculoskeletal pain, aerobic exercise was found to reduce pain sensitization 94 ; whereas motor control exercises alone were not effective in reducing pain in the short-term except in combination with other musculoskeletal therapies 95 . Walking interventions were found to be more effective than nonexercise or non-walking exercise group in reducing pain (short and medium term) and improving function (short, medium and long term) 96 ; whilst whole body vibration exercise alleviated pain (medium and long term) compared with control interventions and no treatment but was as effective as standard treatment 97 amongst adults with chronic low back pain, osteoarthritis, or bromyalgia.…”

Optimal dose and type of exercise to reduce pain, anxiety and increase quality of life in patients with fibromyalgia. A systematic review with meta-analysis

“…Therefore, PEBT-induced improvements in muscle strength and reductions in muscle fatigue ( Estévez-López et al, 2021 ) could explain the results obtained, i.e., the association between circuit-based exercises and pain reduction. In addition, PEBT could favor the production of endogenous opioids and beta-endorphins, causing hypoalgesia due to activation in descending nociceptive inhibitory mechanisms that decrease pain sensitivity ( Tan et al, 2022 ).…”