Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta-analysis

Author(s)

Ferro Moura Franco, Katherinne ^{[1, 2]} ; Lenoir, Dorine ^{[2, 3, 4]} ; dos Santos Franco, Yuri Rafael ^[1] ; Jandre Reis, Felipe Jose ^{[4, 5]} ; Nunes Cabral, Cristina Maria ^[1] ; Meeus, Mira ^{[2, 4, 6]}

Affiliation

^[1] Univ Cidade Sao Paulo, Masters & Doctoral Program Phys Therapy, Sao Paulo - Brazil

^[2] Univ Ghent, Fac Med & Hlth Sci, Dept Rehabil Sci & Physiotherapy, Ghent - Belgium

^[3] Vrije Univ Brussel, Fac Phys Educ & Physiotherapy, Dept Physiotherapy Human Physiol & Anat KIMA, Brussels - Belgium

^[4] Pain Mot Int Res Grp, Brussels - Belgium

^[5] Inst Fed Rio de Janeiro, Phys Therapy Dept, Rio De Janeiro - Brazil

^[6] Univ Antwerp, MOVANT Res Grp, Fac Med & Hlth Sci, Dept Rehabil Sci & Physiotherapy, Antwerp - Belgium

• Document type: Review article
• Source: EUROPEAN JOURNAL OF PAIN; v. 25, n. 1, p. 51-70, JAN 2021.
• Web of Science Citations: 0

Abstract

Background and Objective To compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash-associated disorders (CWAD), and chronic idiopathic neck pain (CINP). Databases and Data Treatment Randomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis. Results Fifty studies with 3,562 participants were included. For fibromyalgia, both aerobic strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50- to 60-min supervised sessions, 2 to 3 times a week, for 13 weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90-min supervised sessions, twice a week, for 10 to 16 weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30- to 60-min supervised sessions, 2 to 3 times a week, for 7 to 12 weeks. Conclusions The choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non-nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills. Prospero registration number CRD42019123271. Significance The pain mechanism must be considered to optimize exercise prescription in patients with different chronic pain profiles. The main message of this article is that low to moderate intensity global exercises performed for a long period of treatment should be performed in patients with nociplastic pain predominance. Additionally, focused and intense exercises for a short period of treatment can be prescribed for patients with nociceptive pain predominance. (AU)

• FAPESP's process: 18/14109-8 - Exercise prescription for patients with chronic pain: a systematic review and Delphi study
• Grantee: Katherinne Ferro Moura Franco
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate