Clin J Pain. 2014 Mar 21. [Epub ahead of print]

Exercise, not to Exercise or how to Exercise in Patients with Chronic Pain? Applying Science to Practice.

Daenen L1, Varkey E, Kellmann M, Nijs J.

Author information

• 1*Department of Neurology, Faculty of Medicine, University of Antwerp (UA), Belgium †Pain in Motion Research Group, Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB), Belgium ‡Institute of Neuroscience and Physiology, University of Gothenburg, Sweden §Faculty of Sport Science, Ruhr-University Bochum, Germany ∥Schools of Human Movement Studies and of Psychology, The University of Queensland, Australia.

Abstract

Exercise is an effective treatment strategy in various chronic musculoskeletal pain disorders, including chronic neck pain, osteoarthritis, headache, fibromyalgia and chronic low back pain. Although exercise can benefit those with chronic pain, some patients (e.g. those with fibromyalgia or chronic whiplash associated disorders) encounter exercise as a pain-inducing stimulus and report symptom flares due to exercise. This paper focuses on benefits and detrimental effects of exercise in patients with chronic pain. It summarizes positive and negative effects of exercise therapy in migraine and tension-type headache and provides an overview of the scientific evidence of dysfunctional endogenous analgesia during exercise in patients with certain types of chronic pain. Further, the paper explains the relationship between exercise and recovery highlighting the need to address recovery strategies as well as exercise regimes during rehabilitation. The characteristics, demands and strategies of adequate recovery to compensate stress from exercise and return to homeostatic balance will be described. Exercise is shown to be effective in the treatment of chronic tension-typeheadache and migraine. Aerobic exercise is the best option in migraine prophylaxis, whereas specific neck and shoulder exercises is a better choice in treating chronic tension-type headache. Besides the consensus, that exercise therapy is beneficial in the treatment of chronic pain, the lack of endogenous analgesia in some chronic pain disorders should not be ignored. Furthermore, optimizing the balance between exercise and recovery is of crucial merit in order to avoid stress-related detrimental effects and achieve optimal functioning in patients with chronic pain.