Exercise in the treatment of chronic pain

Objective: The purpose of this review was to determine how effective exercise is in the treatment of chronic pain. Methodology: The literature search identified three systematic reviews and three randomized controlled trials addressing the effectiveness of exercise for the management of chronic low back pain, one systematic review and one randomized controlled trial addressing chronic neck pain, two systematic reviews and three randomized controlled trials addressing upper extremity pain, and three randomized controlled trials addressing fibromyalgia. Results: Randomized controlled trials were better than systematic reviews for providing details of patient subgroups and of exercise programs, but there was a general lack of evaluation of the different subgroups. The studies also failed to assess the different duration and frequency of exercise programs. For chronic low back pain, a systematic review and two of the three randomized controlled trials found exercise to be effective; other findings were uncertain. For chronic neck pain, both the systematic review and the randomized controlled trial provided generally uncertain results, with only one positive-result study in the systematic review. For upper extremity, positive effects of exercise were shown for chronic lateral epicondylitis and for specific soft tissue shoulder disorders. For fibromyalgia, two of the three randomized controlled trials showed effectiveness of exercise. Conclusions: Exercise is effective for the management of chronic low back pain for up to I year after treatment and for fibromyalgia syndrome for up to 6 months (level 2). There is conflicting evidence (level 4b) about which exercise program is effective for chronic low back pain. For chronic neck pain and for chronic soft tissue shoulder disorders and chronic lateral epicondylitis, evidence of effectiveness of exercise is limited (level 3).