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Type of exercise
Aerobic exercise is particularly important for some
types of chronic pain (e.g., fibromyalgia), whereas strengthening
and flexibility exercises may be helpful in others (back pain, osteoarthritis).
Catastrophizing as a barrier
Fear that movement or activity will worsen pain is
common. Emphasizing that gradual activity will not cause further
harm but instead can be beneficial is essential to activation and rehabilitation.
Stage of change
For patients in precontemplation phase, motivating
them to initiate exercise is the challenge. For many others who
begin an exercise program, getting them to maintain regular exercise more
than a few months is the critical issue. This is analogous to weight
loss, smoking cessation, and other lifestyle or behavioral changes.
Patients should not try to do too much initially. Instead,
they should begin slowly and increase the amount of exercise gradually
over a matter of weeks to months.
Structured vs. home based
The benefits of structured exercise programs demonstrated
in some research studies may have a "voltage drop" when
patients are instructed to begin an exercise program on their own.
Exercise conducted in clinical settings (e.g., physical therapy,
rehabilitation programs) or community settings (e.g., YMCA, fitness
centers) may be reinforced by motivation, group participation, expert
leadership, guidance, and/or an externally imposed regular schedule.
Monotherapy vs. bundled
Many studies of exercise have included other components,
such as education about the particular pain disorder, self-management
techniques, relaxation, and other cognitive-behavioral strategies.
Certainly, exercise coupled with one or more of these is ideal.
Manheimer et al. 2005Manheimer et al. 2005
Meta-analysis (33 trials)
Acupuncture was more effective than sham acupuncture (ES = 0.54)
or no treatment (ES = 0.69) in chronic low back pain.
Manheimer et al. 2007Manheimer et al. 2007
Meta-analysis (11 trials)
Acupuncture was more effective than wait-list (ES = 0.96) or
usual-care controls but only slightly more effective than sham acupuncture
for short-term (ES = 0.35) and long-term (ES = 0.13)
A. White et al. 2007A. White et al. 2007
Knee OA or pain
Meta-analysis (13 trials)
In 5 studies that could be combined (N = 1,334),
acupuncture was superior to sham acupuncture for pain and function
and was also superior to no-intervention controls.
Eccles 2005Eccles 2005
Systematic (21 trials)
Eleven of 18 better-quality trials were positive. Multiple types
of pain conditions were studied.
Pittler et al. 2007Pittler et al. 2007
Meta-analysis (25 trials)
Meta-analysis showed no significant effects. Evidence
was encouraging only for one condition—osteoarthritis.
McCarthy et al. 2006McCarthy et al. 2006
Systematic (five trials)
PEMF therapy yielded insignificant improvement in pain and
Note. ES = effect
size (mean difference between groups divided by pooled standard
deviation); OA = osteoarthritis; PEMF = pulsed