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8 Articles in this Series
Introduction
Bench to Bedside: Clinical Tips From APS Poster Presentations
New Pain Research Underscores the Importance of Sufficient Rest
The Benefits of Exercise for Pain Management
Exercise as Postoperative Analgesic?
How Race Affects Pain
Increased Centralized Pain in African American Patients
Managing Post-Tonsillectomy Pain in Obese Children
Research Offers Insight Into Fibromyalgia and Pain

The Benefits of Exercise for Pain Management

New research presented at this year’s meeting of the American Pain Society reveals new insights on the benefits of exercise for managing pain.

Exercise at any age is beneficial for pain management.The benefits of exercise for managing pain are well documented in a variety of clinical settings, including for nonspecific back pain, for low back pain during pregnancy, for knee osteoarthritis pain, and many other cases of chronic noncancer pain conditions.1-4  However, much of this research focuses on the benefits of strengthening exercises.

High intensity aerobic activity also has been shown to decrease pain significantly, a phenomenon referred to as exercise-induced hypoalgesia (EIH, or runner's high). But for older patients, high-intensity workouts may not be a realistic or a safe option, given the possible disabilities or  complicating health factors they may have. Moreover, a study comparing older and younger healthy adults have shown age differences in EIH after isometric and aerobic exercise, with younger adults experiencing greater EIH compared with older adults.5

This begs the question: Could light physical activity for older adults confer the same benefits as high-intensity aerobics do for healthy adults?

The answer appears to be a resounding yes, according to a research team led by Kelly M. Naugle, PhD, assistant professor in the Department of Kinesiology, Indiana University-Purdue University Indianapolis, Indiana. In a study examining the effects of light physical activity (PA) on 47 older adult patients (15 male; average age = 67.35 yrs ± 5), Dr. Naugle and colleagues found that collected data on total energy expenditure and light PA significantly predicted pain inhibitory function, according to conditioned pain modulation (CPM) tests. The team found that frequent, low-intensity PA was associated with greater pain inhibition in healthy older adults. Moderate to vigorous PA data also predicted pain facilitation on temporal summation (TS) tests for heat pain (at 48° C).6

These results appear to be supported by a second study presented at the meeting, which found that walking for 6 minutes on a treadmill stimulated hypoalgesic benefits. Granted, the test was done on a young, healthy cohort of 20 adults (10 men; average age 21 ± 3.2 yrs), and the hypoalgesia only seemed to be localized to the quadriceps, not systemically throughout the body (deltoid and nailbed).7 In a post-hoc analysis of the study, the researchers from the Physical Therapy Department, Marquette University, Milwaukee, Wisconsin, found that pressure-pain thresholds (PPT) specifically were affected by the exercise, not temporal summation (TS) or conditioned pain modulation (CPM).

But the results of the two studies support the notion that a small amount of low-intensity aerobic exercise can have a marked hypoalgesic benefit, something doctors commonly encourage the patients to do.

Interestingly, a third study presented at this year’s APS meeting similarly found that PPT scores were more sensitive to physical activity and fitness differences than TS or CPM.8 The study had assessed pain sensitivity protocols, a 7-day PA regimen, and cardiorespiratory fitness in 59 pain-free adults (30 male; age range 18-45 yrs). The researchers also found less TS was associated with increasing self-reported rigorous PA (rs = -0.29, P < 0.05). CPM was not associated with activity level, though.

The researchers found PPTs were the highest (lowest sensitivity to pain) in the high fitness group of patients (P ≤ 0.01), with no differences found between the fitness groups for TS (P = 0.21) or CPM (P = 0.97). PPT appeared to improve in relation to how much vigorous PA the patients self-reported and measured through wrist-worn accelerometry (rs = 0.44, P ≤ 0.01).

It should be noted that both tests were conducted on a young and healthy adult cohort, who did not suffer from any chronic noncancer pain conditions. Whether the results of these studies would have been similar with a cohort indeed suffering from chronic pain syndromes remains to be determined.

There is also the discrepancy with the six-minute walk test, which observed hypoalgesia only in the local quadriceps region and not in the deltoid or nailbed,7 while the latter vigorous PA study found PPT increases in the middle deltoid.8 This may suggest rigorous PA confers a different sensory influence than a low-intensity, low-volume physical activity, like the six-minute walk.

Whatever the intensity of the PA may be, it appears regular consistent PA could confer an increased resiliency to chronic pain, and such anti-nociception from exercise could have a lasting benefit on the body, particularly if injury occurs later on.

For more on exercise and postoperative pain, click here.

References

1.     KS Thomas, KR Muir, M Doherty, et al. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ. 2002;325(7367):752.

2.     Garshasbi A, Zadeh SF. The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet.  2005;88(3):271-275.

3.     Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: What works? Pain. 2004;107(1-2):176-190.

4.     Stenström CH. Home exercise in rheumatoid arthritis functional class II: Goal setting versus pain attention. J Rheumatol. 1994;21(4):627-634.

5.     Naugle KM, Naugle KE, Riley JL 3rd. Reduced Modulation of Pain in Older Adults After Isometric and Aerobic Exercise. J Pain. 2016 Mar 15. [Epub ahead of print].

6. Naugle K, Ohlman T, Riley Z, et al.  Light physical activity behavior predicts pain modulatory function in healthy older adults. Poster presented at: Annual Meeting of the American Pain Society; May 11-14, 2016; Austin, Tx. Poster #485.

7.     Alsouhibani A, Hrdina E, Krajewski R, et al.  Exercise-induced hypoalgesia following six minute walk test. Poster presented at: Annual Meeting of the American Pain Society; May 11-14, 2016; Austin, Tx. Poster #465.

8.     Merkle S, Greimann E, Paul C, et al. Pain sensitivity is associated with vigorous physical activity and high cardiorespiratory fitness. Poster presented at: Annual Meeting of the American Pain Society; May 11-14, 2016; Austin, Tx. Poster #184.

 

 

Next summary: Exercise as Postoperative Analgesic?
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