Should exercises be painful in the management of chronic musculoskeletal pain?: a systematic review and meta-analysis

Smith, Benjamin E. and Hendrick, Paul and Smith, Toby O. and Bateman, Marcus and Moffatt, Fiona and Rathleff, Michael Skovdal and Selfe, James and Logan, Pip (2017) Should exercises be painful in the management of chronic musculoskeletal pain?: a systematic review and meta-analysis. British Journal of Sports Medicine . ISSN 1473-0480

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Abstract

Background: Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient’s pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged, compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials.

Methods: Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool and the GRADE system was used to evaluate the quality of evidence.

Results: The literature search identified 9,081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain at medium and long term; and function and disability at short, medium and long term there was no significant difference.

Conclusion: Protocols using painful exercises offer a small, but significant benefit over pain-free exercises at short term, with moderate quality of the evidence. At medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders.

PROSPERO Registration: CRD42016038882

Item Type: Article
Keywords: Systematic review, Meta-analysis, musculoskeletal pain, musculoskeletal disorder, treatment, exercise, effectiveness
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rehabilitation and Ageing
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Health Sciences
Identification Number: 10.1136/bjsports-2016-097383
Depositing User: Eprints, Support
Date Deposited: 05 Apr 2017 10:42
Last Modified: 13 Oct 2017 01:15
URI: http://eprints.nottingham.ac.uk/id/eprint/41764

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