Physical activity and exercise may improve pain severity and physical function with few adverse events among adults with chronic pain, improving quality of life. This according to a Cochrane Review of 21 studies covering 10 different diagnoses, including rheumatoid arthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. The reviews included 381 studies and 37,143 participants. Researchers found:
- Several reviews noted favorable results in pain severity from exercise.
- Physical function was significantly improved in 14 reviews.
- There was variable effect for psychological function and quality of life.
- Only 25% of included studies actively reported adverse events; most were increased soreness or muscle pain, which subsided after a few weeks of the intervention.
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017, Issue 4. Art. No.: CD011279. doi:10.1002/14651858.CD011279.pub3.
Chronic pain—pain lasting >12 weeks—is a common challenging problem in ambulatory care. Medications often fall short of our goals for their use and carry with them important side effects. Those side effects include the potential for GI bleeds, an increased incidence of cardiovascular disease with NSAIDs, and the potential for addiction and abuse with opioid analgesics. Traditionally, we focus on which medication to use for chronic pain, but there is increasing recognition that ancillary approaches to chronic pain, including CBT, exercise, and meditation may yield important benefits. A recent CDC recommendation concluded that there is limited evidence of benefit in treating pain with long-term opioid use and that many non-opioid therapies can improve chronic pain with less risk for harm.1 Exercise, while difficult to initiate and sustain, is attractive in that it is safe and also yields the additional benefit of decreasing cardiovascular risks, improving mood, and decreasing the risk for depression. Based on the above review, exercise is certainly worth a try in patients with chronic pain, as the Cochrane review concludes, “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.” —Neil Skolnik, MD
- CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315(15):1624-1645.
This Week's Must Reads
Must Reads in Pain
Sleep Disturbance and Chronic Pain Intensity, Clin J Pain; ePub 2019 Mar 25; Burgess, et al
Dual Receipt of Rx Opioids & Overdose Death, Ann Intern Med; ePub 2019 Mar 12; Moyo, et al
Opioid-Related Mortality in US by Opioid Type, JAMA Netw Open; 2019 Feb 22; Kiang, et al
Disparities in the Prescription of Opioids, JAMA Intern Med; ePub 2019 Feb 11; Friedman, et al
Trends in Pain Prevalence in US Adults, J Pain; ePub 2019 Jan 15; Nahin, et al