Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions

Abstract

Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. In contrast, EIH is more variable in chronic pain populations and is more frequently impaired; with pain and pain sensitivity decreasing, remaining unchanged or, in some cases, even increasing in response to exercise. Pain exacerbation with exercise may be a major barrier to adherence, precipitating a cycle of physical inactivity that can lead to long-term worsening of both pain and disability. To optimize the therapeutic benefits of exercise, it is important to understand how EIH works, why it may be impaired in some people with chronic pain, and how this should be addressed in clinical practice. In this article, we provide an overview of EIH across different chronic pain conditions. We discuss possible biological mechanisms of EIH and the potential influence of sex and psychosocial factors, both in pain-free adults and, where possible, in individuals with chronic pain. The clinical implications of impaired EIH are discussed and recommendations are made for future research, including further exploration of individual differences in EIH, the relationship between exercise dose and EIH, the efficacy of combined treatments and the use of alternative measures to quantify EIH. Perspective: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions. Existing findings are Partially funded by the Berekuyl Academy Chair, funded by the European College for Lymphatic Therapy, the Netherlands, and awarded to Jo Nijs,

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

“…However, as other studies have shown, the existence of CS predicts poor outcomes obtained with classic local treatments, such as electrotherapy, motor control exercises, and surgery [107,108]. Sometimes PE can increase symptoms because descending inhibitory systems are not working properly [83], and some authors even point out that exercise can induce hyperalgesia if psychosocial factors such as fear of pain, catastrophism, and erroneous beliefs are not previously addressed, and this was not done in the CG [109]. Neither classical physiotherapy intervention nor drug treatment achieved clinically significant improvements.…”

Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain

“…Thus, there are several studies of patients with chronic musculoskeletal pain showing increased pain thresholds and decreased pain sensitivity during and immediately after exercise which probably can be achieved through activation of endogenous pain inhibitory mechanisms [6,9,10]. This latter phenomenon has been termed exercise-induced hypoalgesia (EIH) [7,11].…”

Physiotherapie mit externem Fokus

“…Bei gesunden Probanden löst körperliche Aktivität eine Exercise-Induced Hypoalgesia aus [24,25], bei klinischen Schmerzpatienten jedoch ist die Zuverlässigkeit der erwünschten EIH-Reaktion schlecht [26]. Diesbezüglich stellten Rice et al die Hypothese auf, dass eine EIH-Störung öfters bei Personen mit verstärkter zentraler nozizeptiver Verarbeitung apparent wird [27]. Nicht vollständig geklärt ist hingegen, welche Mechanismen bei chronischen Schmerzpatienten ursächlich für diese Störung sind [27].…”

“…Diesbezüglich stellten Rice et al die Hypothese auf, dass eine EIH-Störung öfters bei Personen mit verstärkter zentraler nozizeptiver Verarbeitung apparent wird [27]. Nicht vollständig geklärt ist hingegen, welche Mechanismen bei chronischen Schmerzpatienten ursächlich für diese Störung sind [27]. Als mögliche Störfaktoren gelten u. a. Dysfunktionen des Immun- [28], des Endocannabinoid- [29,30] sowie des vegetativen Nervensystems [31].…”