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The Role of Exercise and Types of Exercise in the Rehabilitation of Chronic Pain: Specific or Nonspecific Benefits

  • Psychiatric Management of Pain (MR Clark, Section Editor)
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Abstract

Chronic pain is one of the most common complaints seen in general practitioners’ offices, and it contributes to social, emotional, physical, and economical losses. The management of this problem poses challenges for health care providers when the current treatment of choice for chronic pain is pharmacological management, which may not be a sufficient and/or holistic approach to the management of chronic pain. Our goal is to increase awareness of the significance of physical activity, as well as examine additional cost-effective, integrated approaches to help manage the complex and debilitating effects of this condition. This article summarizes the types of exercise in the rehabilitation of chronic pain patients and provides practical recommendations for the clinician based on empirical and clinical experience. This safe, cost-free, nonpharmacologic way of managing pain has been found to reduce anxiety and depression, improve physical capacity, increase functioning and independence, and reduce morbidity and mortality.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mantyselka P, Kumpusalo E, Ahonen R, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain. 2001;89:175–80.

    Article  PubMed  CAS  Google Scholar 

  2. Moskovitz MA. Advances in understanding chronic pain: mechanisms of pain modulation and relationship to treatment. Neurology. 2002;59:S1.

    Google Scholar 

  3. Sleed M, Eccleston C, Beecham J, et al. The economic impact of chronic pain in adolescence: methodological considerations and a preliminary cost-of-illness study. Pain. 2005;119:183–90.

    Article  PubMed  Google Scholar 

  4. Renn C, Dorsey S. Pain management: the physiology of processing pain. AACN Adv Crit Care Nurs. 2005;16:277–90.

    Google Scholar 

  5. American Pain Society: http://www.painfoundation.org/page.asp?file=Newsroom/PainSurveys.htm. Accessed August 2011.

  6. Vorobeychik Y, Chen L, Bush M, et al. Improved opioid analgesic effect following opioid dose reduction. Pain Med. 2008;9:724–7.

    Article  PubMed  Google Scholar 

  7. Rowbotham MC, Lindsey CD. How effective is long-term opioid therapy for chronic noncancer pain? Clin J Pain. 2007;23:300–2.

    Article  PubMed  Google Scholar 

  8. Loeser J. Loeser: address on the decade of pain control and research. J Pain Palliat Care Pharmacother. 2003;17:263–4.

    Google Scholar 

  9. Rasmussen N, Farr L. Beta-endorphin response to an acute pain stimulus. J Neurosci Meth. 2009;177:285–8.

    Article  CAS  Google Scholar 

  10. Mirtz TA, Greene L. Is obesity a risk factor for low back pain? an example of using the evidence to answer a clinical question. Chiropr Osteopathy. 2005;13:2–8.

    Article  Google Scholar 

  11. Mayer J, Mooney V, Dagenais S. Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises. Spine J. 2008;8:96–113.

    Article  PubMed  Google Scholar 

  12. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 2004, 53:25–28.

    Google Scholar 

  13. King AC, Kiernan M. Physical activity and women’s health: issues and future directions. In: Gallant S, Keita G, Royak-Schaler R, editors. Health care for women: psychological, social, and behavioral influence. Washington: American Psychological Association; 1997. p. 133–46.

    Chapter  Google Scholar 

  14. Glenister D. Exercise and mental health: a review. J Roy Soc Promot Health. 1996;116:7–13.

    Article  CAS  Google Scholar 

  15. de Coverley Vsale DMW. Exercise and mental health. Acta Psychiatr Scand. 1987;76:113–20.

    Article  Google Scholar 

  16. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004;292:2388–95.

    Article  PubMed  CAS  Google Scholar 

  17. Meiworm L, Jakob E, Walker UA, et al. Patients with fibromyalgia benefit from aerobic endurance exercise. Clin Reheumatol. 2000;19:253–7.

    Article  CAS  Google Scholar 

  18. Scheman J, Janotta C, Burleson A, et al. Replication and follow-up on treatment outcomes of chronic nonmalignant pain rehabilitation with opioid weaning. J Pain. 2007;8:S51.

    Google Scholar 

  19. Hoffman MD, Shepanski MA, Ruble SB, et al. Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain. Arch Phys Med Rehabil. 2004;85:1183–7.

    Article  PubMed  Google Scholar 

  20. Hoffman M, Hoffman D. Does aerobic exercise improve pain perception and mood? Curr Pain Headache Rep. 2007;11:93–7.

    Article  PubMed  Google Scholar 

  21. Hodges P. Core stability exercise in chronic low back pain. Orthop Clin N Am. 2003;34:1–10.

    Article  Google Scholar 

  22. O’Sullivan P, Phyty D, Twomey L, et al. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22:2959–67.

    Article  PubMed  Google Scholar 

  23. •• Sullivan AB, Covington E, Scheman J. The immediate and long-term benefits of physical conditioning in patients with chronic pain. Pain Medicine. 2010;11(4):524–9. This article presents the only research to date that has looked at the efficacy of interdisciplinary chronic pain programs and, importantly, that has been able to identify immediate mood benefits after only 10 min of exercise.

    Article  PubMed  Google Scholar 

  24. Jones K, Clark S, Bennett R. Prescribing exercise for people with fibromyalgia. AACN Clin Issues. 2002;13:277–93.

    Article  PubMed  Google Scholar 

  25. Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142(9):765–75.

    PubMed  Google Scholar 

  26. Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Cochrane Database Syst Rev. 2006(3).

  27. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guidelines from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–91.

    PubMed  Google Scholar 

  28. North American Spine Society (NASS). Phase III: clinical guidelines for multidisciplinary spine care specialists. Spinal stenosis version 1.0. LaGrange (IL): NASS; 202; 91 pages; www.guideline.gov web site accessed 2-05-07. and Sept 2011.

  29. Dufour N, Thamsborg G, Oefeldt A, et al. Treatment of chronic low back pain: a randomized, Clinical Trial Comparing Group-Based Multidisciplinary Biopsychosocial Rehabilitation and Intensive Individual Therapist-Assisted Back Muscle Strengthening Exercises. Spine. 2010;35:476–569.

    Article  Google Scholar 

  30. Bendix T, Bendix A, Labriola M, et al. Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine. 2000;25:2494–500.

    Article  PubMed  CAS  Google Scholar 

  31. DeLorme T, Watkins A. Techniques of progressive resistance exercise. Arch Phys Med. 1948;29:263–73.

    PubMed  CAS  Google Scholar 

  32. Carpenter DM, Nelson BW. Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exerc. 1999;31(1):18–24.

    Article  PubMed  CAS  Google Scholar 

  33. Machado LAC, deSouza M, Ferreira PH, Ferreira ML. The McKenzie method for low back pain. A systematic review of the literature with a meta-analysis approach. Spine. 2006;31(9):E254–62.

    Article  PubMed  Google Scholar 

  34. Moffet J, McLean S. The role of physiotherapy in the management of non-specific back pain and neck pain. Rheumatology. 2006;45:371–8.

    Article  Google Scholar 

  35. www.McKenziemdt.org web site accessed 9-21-2011.

  36. Jacob R, McKenzie R, Heffner S. McKenzie: spinal rehabilitation methods. In: Liebenson C, editor. Rehabilitation of the spine: a practioner’s manual. 2nd ed. Baltimore: Lippincott Williams & Wilkins; 2007. p. 330–51.

    Google Scholar 

  37. Skikic E, Suad T. The effects of McKenzie exercises for patients with low back pain, our experience. Bosn J Basic Med Sci. 2003;3(4):70–5.

    PubMed  Google Scholar 

  38. Barr KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, part 1. Am J Phys Med Rehabil. 2005;84:473–80.

    Article  PubMed  Google Scholar 

  39. Hides J, Jull G, Richardson C. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine. 2001;26:243–8.

    Article  Google Scholar 

  40. Standaert C, Weinstein S, Rumpeltes J. Evidence-informed management of chronic low back pain with lumbar stabilization exercises. Spine J. 2008;8:114–20.

    Article  PubMed  Google Scholar 

  41. Linton SL, Bradley LA, Jensen I, et al. The secondary prevention of low back pain: a controlled study with follow-up. Pain. 1989;36:197–207.

    Article  PubMed  CAS  Google Scholar 

  42. • O’Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskeletal Disorders. 2009;10. http://www.biomedcentral.com/1471-2474/10/37. This article establishes important definitions and distinctions between static and dynamic stretching. The authors also explore the differential effects of static and dynamic stretching on hamstring flexibility in previously injured patients.

  43. • Sherman KJ, Cherkin DC, Cook AJ, et al. Comparison of yoga versus stretching for chronic low back pain: protocol for the yoga exercise self-care (YES) trial. Trials. 2010;11. http://www.trialsjournal.com/content/11/1/36. This article outlines a comprehensive research protocol with the aim of explaining the mechanisms by which yoga has a therapeutic effect on chronic low back pain. The authors explore unique factors not addressed in other studies, such as fear avoidance, self-efficacy, and changes in cortisol and DHEA.

  44. Galantino JL, Bzdewka TM, Eissler-Russo JL, et al. The impact of modified hatha yoga on chronic low back pain: a pilot study. Altern Ther Health Med. 2004;10:56–9.

    PubMed  Google Scholar 

  45. Williams KA, Petronis J, Smith D, et al. Effect of iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107–17.

    Article  PubMed  Google Scholar 

  46. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain. Ann Inter Med. 2005;143:849–56.

    Google Scholar 

  47. Tekur P, Singphow C, Nagendra HR, Raghuram N. Effect of short-term intensive yoga program on pain, functional disability, and spinal flexibility in chronic low back pain: a randomized control study. J Alternative Compl Med. 2008;14:637–44.

    Article  Google Scholar 

  48. Lim ECW, Poh RLC, Low AY, Wong WP. Effects of pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2011;41:70–80.

    PubMed  Google Scholar 

  49. Jones KD, Burckhardt CS, Clark SR. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. J Rheumatol. 2002;29:1041–8.

    PubMed  Google Scholar 

  50. • Hall A, Maher C, Latimer J, Ferreira M. The effectiveness of tai chi for chronic musculoskeletal pain conditions: a systematic review and meta-analysis. Arthritis Rheum. 2009;61:717–24. This article is the first review of Tai Chi in musculoskeletal pain, which utilizes the meta-analysis techniques.

    Article  PubMed  Google Scholar 

  51. Karjalainen K, Malmivaara A, van Tulder M, Roine R, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults.[update of Cochrane Database Syst Rev. 2000;(3):CD002193; PMID: 10908528]. Cochrane Database of Systematic Reviews. (2):CD002193, 2003.

  52. Turk DC, Swanson KS, Tunks ER. Psychological approaches in the treatment of chronic pain patients-when pills, scalpels, and needles are not enough. Can J Psychiatr. 2008;53(4):213–23.

    Google Scholar 

  53. •• Chou R, Loser JD, Owens, DK, et al. EM Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066–77. This review of the literature informs evidence-based guidelines for the treatment of low back pain.

    Article  PubMed  Google Scholar 

  54. Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011;377(9784):2226–35.

    Article  PubMed  CAS  Google Scholar 

  55. •• Busch H, Bodin L, Bergstrom G, Jensen IB. Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation. Pain. 2011;152:1727–33. This 10-year follow-up study looked at sickness-related work absences in four groups of patients with chronic pain: those treated with physiotherapy, those treated with cognitive behavioral therapy, those treated in a multidisciplinary pain rehabilitation program, and a control group. Those treated in a multidisciplinary pain program showed fewer sick days per year.

    Article  PubMed  Google Scholar 

  56. •• Jeffery MM, Butler M, Stark A, Kane RL. Multidisciplinary pain programs for chronic noncancer pain. Technical Brief No. 8. (Prepared by Minnesota Evidence-based Practice Center under Contract No. 290-07-10064-I.) AHRQ Publication No. 11-EHC064-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011. Prepared for the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, this 294-page document presents the evidence for the effectiveness of comprehensive pain rehabilitation and identifies important gaps in the literature.

  57. Sullivan MJL, Rodgers WM, Wilson PM, et al. An experimental investigation of the relationship between catastrophizing and activity tolerance. Pain. 2002;100:47–53.

    Article  PubMed  Google Scholar 

  58. Vervoot T, Craig KD, Goubert L, et al. Expressive dimensions of pain catastrophizing: a comparison analysis of school children and children with chronic pain. Pain. 2008;134:59–68.

    Article  Google Scholar 

  59. Sullivan MJL, Thibault P, Andrikonute J, et al. Psychological influences on reception-induces summation of activity-related pain in patients with chronic low back pain. Pain. 2009;141:70–8.

    Article  PubMed  Google Scholar 

  60. Thibault P, Loisel P, Durnad MJ, et al. Psychological predictors of pain expression and activity intolerance in chronic pain patients. Pain. 2008;139:47–54.

    Article  PubMed  Google Scholar 

  61. Shelby RA, Somers T, Keefe FJ, et al. Domain specific self-efficacy mediates the impact of pain catastrophizing on pain and disability in overweight and obese osteoarthritis patients. Pain. 2008;9(10):912–9.

    Article  Google Scholar 

  62. Vlaeyen JWS, Linton SJ. Fear avoidance and its consequences in treatment for chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32.

    Article  PubMed  CAS  Google Scholar 

  63. Sullivan MJL, Thorn B, Haythornwaite JA, et al. Theoretical perspectives in the relationship between catastrophizing and pain. Clin J Pain. 2001;17:52–64.

    Article  PubMed  CAS  Google Scholar 

  64. Trost Z, France CR, Thomas JS. Exposure to movement in chronic pain: evidence of successful generalization across a reaching task. Pain. 2008;317:26–33.

    Article  Google Scholar 

  65. Sarda J, Nicholas MK, Asghari A, et al. The contribution of self-efficacy and depression to disability and work status in chronic pain patients: a comparison between Australian and Brazilian samples. Eur J Pain. 2009;13(2):189–95.

    Article  PubMed  Google Scholar 

  66. Guzman J, Esmail R, Karjalainen K, et al. Multidisciplinary rehabilitation for chronic low back pain: systematic review. Br Med J. 2001;322(7301):1511–6.

    Article  CAS  Google Scholar 

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Sullivan, A.B., Scheman, J., Venesy, D. et al. The Role of Exercise and Types of Exercise in the Rehabilitation of Chronic Pain: Specific or Nonspecific Benefits. Curr Pain Headache Rep 16, 153–161 (2012). https://doi.org/10.1007/s11916-012-0245-3

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