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A Meta-Analytic Review of the Hypoalgesic Effects of Exercise

Published:November 09, 2012DOI:https://doi.org/10.1016/j.jpain.2012.09.006

      Abstract

      The purpose of this article was to examine the effects of acute exercise on pain perception in healthy adults and adults with chronic pain using meta-analytic techniques. Specifically, studies using a repeated measures design to examine the effect of acute isometric, aerobic, or dynamic resistance exercise on pain threshold and pain intensity measures were included in this meta-analysis. The results suggest that all 3 types of exercise reduce perception of experimentally induced pain in healthy participants, with effects ranging from small to large depending on pain induction method and exercise protocol. In healthy participants, the mean effect size for aerobic exercise was moderate (dthr = .41, dint = .59), while the mean effect sizes for isometric exercise (dthr = 1.02, dint = .72) and dynamic resistance exercise (dthr = .83, dint = .75) were large. In chronic pain populations, the magnitude and direction of the effect sizes were highly variable for aerobic and isometric exercise and appeared to depend on the chronic pain condition being studied as well as the intensity of the exercise. While trends could be identified, the optimal dose of exercise that is needed to produce hypoalgesia could not be systematically determined with the amount of data available.

      Perspective

      This article presents a quantitative review of the exercise-induced hypoalgesia literature. This review raises several important questions that need to be addressed while also demonstrating that acute exercise has a hypoalgesic effect on experimentally induced pain in healthy adults, and both a hypoalgesic and hyperalgesic effect in adults with chronic pain.

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      References

        • Bartholomew J.B.
        • Lewis B.P.
        • Linder D.E.
        • Cook D.B.
        Post-exercise analgesia: Replication and extension.
        J Sports Sci. 1996; 14: 329-334
        • Bulbulian R.
        Endogenous opioid effects on motoneuron pool excitability: Potential analgesic effect of acute exercise.
        J Manipulative Physiol Ther. 2002; 25: 209-215
        • Cook D.B.
        • Stegner A.J.
        • Ellingson L.D.
        Exercise alters pain sensitivity in Gulf War veterans with chronic musculoskeletal pain.
        J Pain. 2010; 11: 764-772
        • Dannecker E.A.
        • Koltyn K.F.
        • Riley 3rd, J.L.
        • Robinson M.E.
        The influence of endurance exercise on delayed onset muscle soreness.
        J Sports Med Phys Fitness. 2002; 42: 458-465
        • Dietrich A.
        • McDaniel W.F.
        Endocannabinoids and exercise.
        Br J Sports Med. 2004; 38: 536-541
        • Droste C.
        • Meyer-Blankenburg M.
        • Greenlee M.W.
        • Roskamm H.
        Effect of physical exercise on pain thresholds and plasma beta-endorphins in patients with silent and symptomatic myocardial ischemia.
        Eur Heart J. 1988; 9: 25-33
        • Droste C.
        • Greenlee M.
        • Schreck M.
        Experimental pain thresholds and plasma beta-endorphin levels during exercise.
        Med Sci Sports Exerc. 1991; 23: 334-342
        • Fallentin N.
        • Jorgensen K.
        • Simonsen E.B.
        Motor unit recruitment during prolonged isometric contractions.
        Eur J Appl Physiol Occup Physiol. 1993; 67: 335-341
        • Focht B.
        • Koltyn K.
        Alterations in pain perception after resistance exercise performed in the morning and evening.
        J Strength Cond Res. 2009; 23: 891-897
        • Fuller A.
        • Robinson M.
        A test of exercise analgesia using signal detection theory and a within-subjects design.
        Percept Mot Skills. 1993; 76: 1299-1310
        • Garland S.J.
        • Enoka R.M.
        • Serrano L.P.
        • Robinson G.A.
        Behavior of motor units in human biceps brachii during a submaximal fatiguing contraction.
        J Appl Physiol. 1994; 76: 2411-2419
        • Ghione S.
        Hypertension-associated hypalgesia: Evidence in experimental animals and humans, pathological mechanisms, and potential clinical consequences.
        Hypertension. 1996; 28: 494-504
        • Ghione S.
        • Rosa C.
        • Panattoni E.
        • Nuti M.
        • Mezzasalma L.
        • Giuliano G.
        Comparison of sensory and pain threshold in tooth pulp stimulation in normotensive man and essential hypertension.
        J Hypertens Supple. 1985; 3: S113-S115
        • Gleser L.J.
        • Olkin I.
        Stochastically dependent effect sizes.
        in: Cooper H. Hedges L.V. The Handbook of Research Synthesis. Sage Russell Foundation, New York, NY1994: 339-355
        • Goldfarb A.H.
        • Jamurtas A.Z.
        Beta-endorphin response to exercise. An update.
        Sports Med. 1997; 24: 8-16
        • Guieu R.
        • Blin O.
        • Pouget J.
        • Serratrice G.
        Nociceptive threshold and physical activity.
        Can J Neurol Sci. 1992; 19: 69-71
        • Gurevich M.
        • Kohn P.M.
        • Davis C.
        Exercise-induced analgesia and the role of reactivity in pain sensitivity.
        J Sports Sci. 1994; 12: 549-559
        • Haier R.J.
        • Quaid K.
        • Mills J.S.C.
        Naloxone alters pain perception after jogging.
        Psychiatry Res. 1981; 5: 231-232
        • Hedges L.
        Distribution theory for Glass's estimator of effect size and related estimators.
        J Educat Stat. 1981; 6: 490-499
        • Hedges L.
        Estimation of effect size from a series of independent experiments.
        Psychol Bull. 1982; 92: 490-499
        • Hoeger Bement M.
        • Dicapo J.
        • Rasiarmos R.
        • Hunter S.
        Dose response of isometric contractions on pain perception in healthy adults.
        Med Sci Sports Exerc. 2008; 40: 1880-1889
        • Hoeger Bement M.
        • Rasiarmos R.L.
        • DiCapo J.M.
        • Lewis A.
        • Keller M.L.
        • Harkins A.L.
        • Hunter S.K.
        The role of the menstrual cycle phase in pain perception before and after an isometric fatiguing contraction.
        Eur J Appl Physiol. 2009; 106: 105-112
        • Hoeger Bement M.
        • Sluka K.A.
        Low-intensity exercise reverses chronic muscle pain in the rat in a naloxone-dependent manner.
        Arch Phys Med Rehabil. 2005; 86: 1736-1740
        • Hoeger Bement M.
        • Wyer A.
        • Hartley S.
        • Drewek B.
        • Harkins A.L.
        • Hunter S.K.
        Pain perception after isometric exercise in women with fibromyalgia.
        Arch Phys Med Rehabil. 2011; 92: 89-95
        • Hoeger Bement M.
        • Wyer A.
        • Hartley S.
        • Yoon T.
        • Hunter S.K.
        Fatiguing exercise attenuates pain-induced corticomotor excitability.
        Neurosci Lett. 2009; 452: 209-213
        • Hoffman M.D.
        • Shepanski M.
        • Ruble S.
        • Valic Z.
        • Buckwalter J.
        • Clifford P.
        Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.
        Arch Phys Med Rehabil. 2004; 85: 1183-1187
        • Hoffman M.D.
        • Shepanski M.S.
        • Mackenzie S.P.
        • Clifford P.S.
        Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain.
        J Rehabil Res Dev. 2005; 42: 183-190
        • Hoffman P.
        • Skarphedinsson J.O.
        • Delle M.
        • Thoren P.
        Electrical stimulation of the gastrocnemius muscle in the spontaneously hypertensive rat increases the pain threshold: Role of different serotonergic receptions.
        Acta Physiol Scand. 1990; 138: 125-131
        • Janal M.N.
        • Colt E.W.D.
        • Clark W.C.
        • Glusman M.
        Pain sensitivity, mood and plasma endocrine levels in man following long distance running: Effects of Naloxone.
        Pain. 1984; 19: 13-25
        • Kadetoff D.
        • Kosek E.
        The effects of static muscular contraction on blood pressure, heart rate, pain ratings and pressure pain thresholds in healthy individuals and patients with fibromyalgia.
        Eur J Pain. 2007; 11: 39-47
        • Kemppainen P.
        • Hämäläinen O.
        • Könönen M.
        Different effects of physical exercise on cold pain sensitivity in fighter pilots with and without the history of acute in-flight neck pain attacks.
        Med Sci Sports Exerc. 1988; 30: 577-582
        • Kemppainen P.
        • Pertovaara A.
        • Huopaniemi T.
        • Johansson G.
        • Karonen S.
        Modification of dental pain and cutaneous thermal sensitivity by physical exercise in man.
        Brain Res. 1985; 360: 33-40
        • Kemppainen P.
        • Pertovaara A.
        • Huopaniemi T.
        • Johansson G.
        Elevation of dental pain threshold induced in man by physical exercise is not reversed by cyproheptadine-mediated suppression of growth hormone release.
        Neurosci Lett. 1986; 70: 388-392
        • Kemppainen P.
        • Paalasmaa P.
        • Pertovaara A.
        • Alila A.
        • Johansson G.
        Dexamethasone attenuates exercise-induced dental analgesia in man.
        Brain Res. 1990; 519: 329-332
        • Kojo I.
        • Pertovaara A.
        The effects of stimulus area and adaptation temperature on human heat pain and warm thresholds.
        Int J Neurosci. 1987; 32: 875-880
        • Koltyn K.
        Analgesia following exercise.
        Sports Med. 2000; 29: 85-98
        • Koltyn K.
        Exercise-induced hypoalgesia and intensity of exercise.
        Sports Med. 2002; 32: 477-487
        • Koltyn K.
        • Arbogast R.
        Perception of pain after resistance exercise.
        Br J Sports Med. 1998; 32: 20-24
        • Koltyn K.
        • Garvin A.
        • Gardiner R.
        • Nelson T.
        Perception of pain following aerobic exercise.
        Med Sci Sport Exerc. 1996; 28: 1418-1421
        • Koltyn K.
        • Trine M.
        • Stegner A.
        • Tobar D.
        Effect of isometric exercise on pain perception and blood pressure in men and women.
        Med Sci Sport Exerc. 2001; 33: 282-290
        • Koltyn K.
        • Umeda M.
        Exercise, hypoalgesia, and blood pressure.
        Sports Med. 2006; 36: 207-214
        • Koltyn K.
        • Umeda M.
        Contralateral attenuation of pain after short-duration submaximal isometric exercise.
        J Pain. 2007; 8: 887-892
        • Kosek E.
        • Ekholm J.
        Modulation of pressure pain thresholds during and following isometric contractions.
        Pain. 1995; 61: 481-486
        • Kosek E.
        • Ekholm J.
        • Hansson P.
        Modulation of pressure pain thresholds during and following isometric contractions in patients with fibromyalgia and in healthy controls.
        Pain. 1996; 64: 415-423
        • Kosek E.
        • Lundberg L.
        Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals.
        Eur J Pain. 2007; 7: 251-258
        • Lannersten L.
        • Kosek E.
        Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia.
        Pain. 2010; 151: 77-86
        • Lovick T.A.
        Integrated activity of cardiovascular and pain regulatory systems: Role in adaptive behavioral responses.
        Prog Neurobiol. 1993; 40: 631-644
        • Meeus M.
        • Roussel N.
        • Truijen S.
        • Nijs J.
        Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: An experimental study.
        J Rehab Med. 2010; 42: 884-890
        • Mense S.
        • Simons D.G.
        Muscle Pain: Understanding its nature, diagnosis, and treatment.
        Lippincott Williams & Wilkins, Philadelphia, PA2001
        • Mogil J.S.
        • Belknap J.K.
        Sex and genotype determine the selective activation of neurochemically distinct mechanisms of swim stress-induced analgesia.
        Pharmacol Biochem Behav. 1997; 56: 61-66
        • Newcomb L.W.
        • Koltyn K.
        • Morgan W.P.
        • Cook D.B.
        Influence of preferred versus prescribed exercise on pain in fibromyalgia.
        Med Sci Sports Exerc. 2011; 43: 1106-1113
        • Olausson B.
        • Eriksson E.
        • Ellmarker L.
        Effects of naloxone on dental pulp pain threshold following muscle exercise and low frequency transcutaneous nerve stimulation: A comprehensive study in man.
        Acta Physiol Scand. 1986; 126: 299-305
        • Paalasmaa P.
        • Kemppainen P.
        • Pertovaara A.
        Modulation of skin sensitivity by dynamic and isometric exercise in man.
        Eur J Appl Physiol. 1991; 62: 279-285
        • Padawer W.J.
        • Levine F.M.
        Exercise-induced analgesia: Fact or artifact?.
        Pain. 1992; 48: 131-135
        • Paulev P.E.
        • Thorboll J.E.
        • Nielsen U.
        • Kruse P.
        • Jordal R.
        • Bach F.W.
        • Fenger M.
        • Pokorski M.
        Opioid involvement in the perception of pain due to endurance exercise in trained man.
        Jpn J Physiol. 1989; 38: 507-517
        • Pertovaara A.
        • Huopaniemi T.
        • Virtanen A.
        • Johansson G.
        The influence of exercise on dental pain thresholds and the release of stress hormones.
        Physiol Behav. 1984; 33: 923-926
        • Pertovaara A.
        • Kemppainen P.
        • Johansson G.
        • Karonen S.L.
        Ischemic pain nonsegmentally produces a predominant reduction of pain and thermal sensitivity in man: A selective role for endogenous opioids.
        Brain Res. 1982; 251: 83-92
        • Portney L.G.
        • Watkins M.P.
        Foundations of clinical research: Applications to practice.
        Appleton and Lang, East Norwalk, CT1993
        • Price D.
        • Von der Gruen A.
        • Miller J.
        • Rafii A.
        • Price C.
        A psychophysical analysis of morphine analgesia.
        Pain. 1985; 22: 261-269
        • Randich A.
        • Maixner W.
        Interactions between cardiovascular and pain regulatory systems.
        Ann N Y Acad Sci. 1986; 467: 371-384
        • Ring C.
        • Edwards L.
        • Kavussanu M.
        Effects of isometric exercise on pain are mediated by blood pressure.
        Biol Psychol. 2008; 78: 123-128
        • Ruble S.
        • Hoffman M.
        • Shepanski M.
        • Valic Z.
        • Buckwalter J.
        • Clifford P.
        Thermal pain perception after aerobic exercise.
        Arch Phys Med Rehabil. 2005; 86: 1019-1023
        • Schobel H.P.
        • Handwerker H.O.
        • Schmieder R.E.
        • Heusser K.
        • Dominiak P.
        • Luft F.C.
        Effects of naloxone on hemodynamic and sympathetic nerve responses to pain in normotensive vs. borderline hypertensive men.
        J Auton Nerv Syst. 1998; 69: 49-55
        • Stagg N.J.
        • Mata H.P.
        • Ibrahim M.M.
        • Henriksen E.J.
        • Porreca F.
        • Vanderah T.W.
        • Malan P.T.
        Regular exercise reverses sensory hypersensitivity in a rat neuropathic pain model: Role of endogenous opioids.
        Anesthesiology. 2011; 114: 940-948
        • Staud R.
        • Robinson M.
        • Price D.
        Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls.
        Pain. 2005; 118: 176-184
        • Sternberg W.
        • Bailin D.
        • Grant M.
        • Gracely R.H.
        Competition alters the perception of noxious stimuli in male and female athletes.
        Pain. 1998; 76: 231-238
        • Sternberg W.
        • Bokat C.
        • Kass L.
        • Alboyadjian A.
        • Gracely R.
        Sex-dependent components of the analgesia produced by athletic competition.
        J Pain. 2001; 2: 65-74
        • Umeda M.
        • Newcomb L.
        • Ellingson L.
        • Koltyn K.
        Examination of the dose-response relationship between pain perception and blood pressure elevations induced by isometric exercise.
        Biol Psychol. 2010; 85: 90-96
        • Umeda M.
        • Newcomb L.
        • Koltyn K.
        Influence of blood pressure elevations by isometric exercise on pain perception in women.
        Int J Psychophysiol. 2009; 74: 45-52
        • Vecchiet L.
        • Marini I.
        • Colozi A.
        • Feroldi P.
        Effects of aerobic exercise on muscular pain sensitivity.
        Clin Therapist. 1984; 6: 354-363
        • Vierck C.J.
        • Cannon R.L.
        • Fry G.
        • Maixner W.
        • Whitsel B.L.
        Characteristics of temporal summation of second pain sensations elicited by brief contact of glabrous skin by a preheated thermode.
        J Neurophysiol. 1997; 78: 992-1002
        • Vierck C.
        • Staud R.
        • Price D.
        • Cannon R.
        • Mauderli A.
        • Martin A.
        The effect of maximal exercise on temporal summation of second pain (windup) in patients with fibromyalgia syndrome.
        J Pain. 2001; 2: 334-344
        • Villemure C.
        • Bushnell M.C.
        Cognitive modulation of pain: How do attention and emotion influence pain processing?.
        Pain. 2002; 95: 195-199
        • Zamir N.
        • Maixner W.
        Interactions between cardiovascular and pain regulatory systems.
        Ann NY Aca Sci. 1986; 467: 371-384