Limited evidence that exercise improves chronic pain
By Marilynn Larkin
NEW YORK (Reuters Health) - Little quality evidence exists to support the use of physical activity in chronic pain management, although some studies suggest there may be favorable effects on pain severity, researchers say.
Whereas rest was recommended for many years for individuals with chronic pain, physical activity is increasingly being promoted in healthcare systems for various pain conditions. To investigate the evidence base for such interventions, as well as efficacy and safety, Dr. Andrew Moore of the University of Oxford, UK and colleagues searched the Cochrane Database of Systematic Reviews for relevant reviews and randomized controlled trials through March 2016.
The team extracted data on self-reported pain severity, physical and psychological function, quality of life, adherence, adverse events and mortality.
As reported online April 24 in the Cochrane Database of Systematic Reviews, the researchers examined 21 reviews including 381 studies with more than 37,000 participants. Of those, 264 studies (19,642 participants) looked at exercise versus no exercise (or a minimal intervention) in adults with chronic pain, and these were included in the analysis.
The pain conditions covered included rheumatoid arthritis and osteoarthritis, fibromyalgia, low back pain, intermittent claudication, mechanical neck disorder, spinal cord injury, postpolio syndrome and dysmenorrhea.
Interventions included yoga, Pilates, tai chi, aerobic, strength, flexibility, range of motion, core strength and balance training.
Dr. Moore told Reuters Health, “Right now, despite a few straws in the wind, we can’t pin the evidence down to saying what exercise in what condition at what intensity and for what duration will produce real and important benefits to people with chronic pain.”
“There was no clear message,” he said by email. “There was definitely no message that physical activity was a bad thing, and of course we know that being active is beneficial in all sorts of different ways, from heart disease to cancer.”
“The problems we found were that individual studies were small - and that limits their ability to come up with useful findings,” he said. “Many were often short duration as well, and we expect benefits to occur after some time. And of course they tested all sorts of physical activity and intensities of activity.”
Overall, the team found limited evidence of improvement in pain severity, some evidence of improved physical function and a variable effect on quality of life and psychological function.
However, they note, “results are inconsistent and evidence is low quality.”
Future research should include baseline values for outcome measures in intervention and control groups; relevant information about participants; pain results reported as the number of people achieving 50%, 30% and 10% pain relief; as well as median, range and standard deviation of results to enable readers to review the effects of outliers who may have skewed the data, the authors advise.
Dr. Moore said, “We need to look harder and better.”
American Council on Exercise spokesperson Cris Dobrosielski told Reuters Health that his own experience over 30 years “provides substantial and convincing evidence of the benefit of exercise with chronic pain patients.”
“More high quality research will significantly increase the likelihood that the medical community and the insurance industry will utilize and support this modality in pain management protocols,” he concluded.
SOURCE: http://bit.ly/2qEtmGK
Cochrane Database Syst Rev 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - http://about.reuters.com/fulllegal.asp