Advertisement

Der Schmerz

, Volume 30, Issue 5, pp 421–428 | Cite as

Körperliche Aktivität und muskuloskeletale Schmerzen

Ein Fokus-Review aus dem MiSpEx-Forschungsverbund
  • C. Titze
  • H. Gajsar
  • M. I. Hasenbring
Schwerpunkt

Zusammenfassung

Chronische Schmerzerkrankungen gehen häufig mit subjektiv empfundenen Beeinträchtigungen in der körperlichen Aktivität einher. Bislang existieren jedoch keine allgemeingültigen Empfehlungen dafür, welches Maß körperlicher Aktivität heilungsfördernd ist und wie Alltagsaktivität und therapeutische Übungen für einzelne Patientenpopulationen gestaltet werden sollten. Der vorliegende Beitrag gibt einen Überblick über die Effekte körperlicher Aktivität bei Schmerzpatienten und Gesunden in verschiedenen Lebenskontexten. Die empirische Befundlage gibt Hinweise darauf, dass körperliche Aktivität je nach Ausmaß und Intensität gesundheitsförderlich oder aber schmerzerzeugend wirken kann. Vor allem eine kurzfristige Verschlimmerung der Beschwerden nach einer therapeutischen Intervention kann ein maßgebliches Problem für die Adhärenz der Patienten darstellen. Studien zum Einfluss psychosozialer Risikofaktoren auf Schmerz und die körperliche Beeinträchtigung weisen auf die Notwendigkeit stärker individualisierter Behandlungsverfahren hin.

Schlüsselwörter

Chronischer Schmerz Psychosoziale Risikofaktoren Schmerztherapie Bewegungsinduzierte Hypoalgesie Alltagsaktivitäten 

Physical activity and musculoskeletal pain

A focus review within the MiSpEx research group

Abstract

Chronic pain diseases are often accompanied by a subjectively perceived impairment in physical activity. Moreover, to date it has not been possible to formulate general recommendations on a therapeutic quantity of physical activity and how activities of daily life and movement exercises should be designed for specific patient populations. This article gives an overview about the effects of physical activity in chronic pain patients and healthy subjects with respect to the different contexts of activities of daily living. Empirical evidence suggests that physical activity might have health-promoting or even pain-provoking effects, depending on the amount and intensity. In particular, a temporary exacerbation of symptoms after an exercise intervention could pose a serious problem concerning patient adherence to treatment. Studies investigating the influence of psychosocial risk factors on pain and disability indicate the need for more individualized pain management techniques.

Keywords

Chronic pain Risk factors, psychosocial Pain management Hypoalgesia, exercise-induced Activities of daily living 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Titze, H. Gajsar und M.I. Hasenbring geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, Charlot J, Dreiser RL, Legrand E, Rozenberg S, Vautravers P (2000) The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine 25(4 Suppl):1 S–33 SPubMedCrossRefGoogle Scholar
  2. 2.
    Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr., Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS (2011) 2011 Compendium of Physical Activities: A second update of codes and MET values. Med Sci Sports Exerc 43(8):1575–1581PubMedCrossRefGoogle Scholar
  3. 3.
    Arendt-Nielsen L, Lautenbacher S (2004) Assessment of pain perception. In: Lautenbacher S, Fillingim RB (Hrsg) Pathophysiology of pain perception. Springer, Boston, S 25–42CrossRefGoogle Scholar
  4. 4.
    Bousema EJ, Verbunt JA, Seelen HAM, Vlaeyen JWS, Knottnerus JA (2007) Disuse and physical deconditioning in the first year after the onset of back pain. Pain 130(3):279–286PubMedCrossRefGoogle Scholar
  5. 5.
    Burrows NJ, Booth J, Sturnieks DL, Barry BK (2014) Acute resistance exercise and pressure pain sensitivity in knee osteoarthritis: A randomised crossover trial. Osteoarthr Cartil 22(3):407–414PubMedCrossRefGoogle Scholar
  6. 6.
    Côté JN, Hoeger Bement MK (2010) Update on the relation between pain and movement: Consequences for clinical practice. Clin J Pain 26(9):754–762PubMedCrossRefGoogle Scholar
  7. 7.
    Crombez G, Vlaeyen JW, Heuts PH, Lysens R (1999) Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability. Pain 80(1–2):329–339PubMedCrossRefGoogle Scholar
  8. 8.
    Daenen L, Varkey E, Kellmann M, Nijs J (2015) Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clin J Pain 31(2):108–114PubMedCrossRefGoogle Scholar
  9. 9.
    Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP, American College of Sports Medicine (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc 43(7):1334–1359PubMedCrossRefGoogle Scholar
  10. 10.
    Ge H, Nie H, Graven-Nielsen T, Danneskiold-Samsøe B, Arendt-Nielsen L (2012) Descending pain modulation and its interaction with peripheral sensitization following sustained isometric muscle contraction in fibromyalgia. Eur J Pain 16(2):196–203PubMedCrossRefGoogle Scholar
  11. 11.
    Hägg GM (1991) Static work load and occupational myalgia – a new explanation model. In: Anderson PA, Hobart DJ, Danhoff JV (Hrsg) Electromyographical kinesiology. Elsevier, Amsterdam, S 141–144Google Scholar
  12. 12.
    Hanvold TN, Waersted M, Veiersted KB (2012) Long periods with uninterrupted muscle activity related to neck and shoulder pain. Work 41(Suppl 1):2535–2538PubMedGoogle Scholar
  13. 13.
    Hasenbring MI, Hallner D, Klasen B, Streitlein-Böhme I, Willburger R, Rusche H (2012) Pain-related avoidance versus endurance in primary care patients with subacute back pain: Psychological characteristics and outcome at a 6‑month follow-up. Pain 153(1):211–217PubMedCrossRefGoogle Scholar
  14. 14.
    Hasenbring MI, Plaas H, Fischbein B, Willburger R (2006) The relationship between activity and pain in patients 6 months after lumbar disc surgery: Do pain-related coping modes act as moderator variables? Eur J Pain 10(8):701–709PubMedCrossRefGoogle Scholar
  15. 15.
    Hasenbring MI, Verbunt JA (2010) Fear-avoidance and endurance-related responses to pain: New models of behavior and their consequences for clinical practice. Clin J Pain 26(9):747–753PubMedCrossRefGoogle Scholar
  16. 16.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A (2007) Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 39(8):1423–1434PubMedCrossRefGoogle Scholar
  17. 17.
    Heneweer H, Vanhees L, Picavet HSJ (2009) Physical activity and low back pain: A U‑shaped relation? Pain 143(1–2):21–25PubMedCrossRefGoogle Scholar
  18. 18.
    Hodges PW, Smeets RJ (2015) Interaction between pain, movement, and physical activity: Short-term benefits, long-term consequences, and targets for treatment. Clin J Pain 31(2):97–107PubMedCrossRefGoogle Scholar
  19. 19.
    Janal MN, Colt EW, Clark CW, Glusman M (1984) Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: Effects of naloxone. Pain 19(1):13–25PubMedCrossRefGoogle Scholar
  20. 20.
    Kadetoff D, Kosek E (2007) The effects of static muscular contraction on blood pressure, heart rate, pain ratings and pressure pain thresholds in healthy individuals and patients with fibromyalgia. Eur J Pain 11(1):39–47PubMedCrossRefGoogle Scholar
  21. 21.
    Koltyn KF (2000) Analgesia following exercise: A review. Sports Med 29(2):85–98PubMedCrossRefGoogle Scholar
  22. 22.
    Koltyn KF (2002) Exercise-induced hypoalgesia and intensity of exercise. Sports Med 32(8):477–487PubMedCrossRefGoogle Scholar
  23. 23.
    Koltyn KF, Brellenthin AG, Cook DB, Sehgal N, Hillard C (2014) Mechanisms of exercise-induced hypoalgesia. J Pain 15(12):1294–1304PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Lannersten L, Kosek E (2010) Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain 151(1):77–86PubMedCrossRefGoogle Scholar
  25. 25.
    Lin CW, McAuley JH, Macedo L, Barnett DC, Smeets RJ, Verbunt JA (2011) Relationship between physical activity and disability in low back pain: A systematic review and meta-analysis. Pain 152(3):607–613PubMedCrossRefGoogle Scholar
  26. 26.
    Linke SE, Gallo LC, Norman GJ (2011) Attrition and adherence rates of sustained vs. intermittent exercise interventions. Ann Behav Med 42(2):197–209PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Naugle KM, Fillingim RB, Riley JL (2012) A meta-analytic review of the hypoalgesic effects of exercise. J Pain 13(12):1139–1150PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Naugle KM, Naugle KE, Fillingim RB, Riley JL (2014) Isometric exercise as a test of pain modulation: Effects of experimental pain test, psychological variables, and sex. Pain Med 15(4):692–701PubMedCrossRefGoogle Scholar
  29. 29.
    Newcomb LW, Koltyn KF, Morgan WP, Cook DB (2011) Influence of preferred versus prescribed exercise on pain in fibromyalgia. Med Sci Sports Exerc 43(6):1106–1113PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Oja P, Titze S (2011) Physical activity recommendations for public health: Development and policy context. EPMA J 2(3):253–259PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Plaas H, Sudhaus S, Willburger R, Hasenbring MI (2014) Physical activity and low back pain: The role of subgroups based on the avoidance-endurance model. Disabil Rehabil 36(9):749–755PubMedCrossRefGoogle Scholar
  32. 32.
    Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M (2008) A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. Int J Behav Nutr Phys Act 5(1):56. doi: 10.1186/1479-5868-5-56 PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Samitz G, Egger M, Zwahlen M (2011) Domains of physical activity and all-cause mortality: Systematic review and dose-response meta-analysis of cohort studies. Int J Epidemiol 40(5):1382–1400PubMedCrossRefGoogle Scholar
  34. 34.
    Shaw WS, Pransky GS, Main CJ (2012) Work-related risk factors for transition to chronic back pain and disability. In: Hasenbring MI, Rusu AC, Turk DC (Hrsg) From acute to chronic back pain. Risk factors, mechanisms, and clinical implications. Oxford University Press, Oxford New York, S 377–388CrossRefGoogle Scholar
  35. 35.
    Sitthipornvorakul E, Janwantanakul P, Purepong N, Pensri P, van der Beek AJ (2011) The association between physical activity and neck and low back pain: A systematic review. Eur Spine J 20(5):677–689PubMedCrossRefGoogle Scholar
  36. 36.
    Umeda M, Newcomb LW, Ellingson LD, Koltyn KF (2010) Examination of the dose-response relationship between pain perception and blood pressure elevations induced by isometric exercise in men and women. Biol Psychol 85(1):90–96PubMedCrossRefGoogle Scholar
  37. 37.
    Vaegter HB, Handberg G, Graven-Nielsen T (2014) Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain 155(1):158–167PubMedCrossRefGoogle Scholar
  38. 38.
    Vaegter HB, Handberg G, Graven-Nielsen T (2015) Isometric exercises reduce temporal summation of pressure pain in humans. Eur J Pain 19(7):973–983PubMedCrossRefGoogle Scholar
  39. 39.
    Vaegter HB, Handberg G, Graven-Nielsen T (2016) Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculoskeletal pain patients with high pain sensitivity. Clin J Pain 32(1):58–69PubMedCrossRefGoogle Scholar
  40. 40.
    van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 20(1):19–39PubMedCrossRefGoogle Scholar
  41. 41.
    van Tulder MW, Koes BW, Bouter LM (1995) A cost-of-illness study of back pain in The Netherlands. Pain 62(2):233–240PubMedCrossRefGoogle Scholar
  42. 42.
    Verbunt J, Smeets RJ, Wittink H (2012) Unmasking the deconditioning paradigm for chronic low back pain patients. In: Hasenbring MI, Rusu AC, Turk DC (Hrsg) From acute to chronic back pain. Risk factors, mechanisms, and clinical implications. Oxford University Press, Oxford New York, S 185–200CrossRefGoogle Scholar
  43. 43.
    Wagenmakers AJ, Coakley JH, Edwards RH (1988) The metabolic consequences of reduced habitual activities in patients with muscle pain and disease. Ergonomics 31(11):1519–1527PubMedCrossRefGoogle Scholar

Copyright information

© Deutsche Schmerzgesellschaft e.V. Published by Springer-Verlag Berlin Heidelberg - all rights reserved 2016

Authors and Affiliations

  1. 1.Medizinische Psychologie und Medizinische SoziologieRuhr-Universität BochumBochumDeutschland

Personalised recommendations