PM & R : the journal of injury, function, and rehabilitation · 2026
Effects of exercise-induced hypoalgesia on pressure pain threshold in patients with chronic musculoskeletal pain: A systematic review and meta-analysis.
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Salazar-Méndez Joaquín, Benavides-Méndez Fabiola, Núñez-Cortés Rodrigo, Araya-Quintanilla Felipe, Viscay-Sanhueza Nelson, Sazo-Rodríguez Sergio, Díaz-Ramírez Felipe, Meza-Carvajal Javier, Floriano Landim Síbila, Fuentes Jorge
Аннотация
OBJECTIVE: To determine the effects of exercise programs on exercise-induced hypoalgesia in people with chronic musculoskeletal pain.
LITERATURE SURVEY: This systematic review and meta-analysis included a search of MEDLINE, Web of Science, CINAHL, SCOPUS, and EMBASE databases from inception until May 18, 2025. Randomized controlled trials that examined aerobic or anaerobic exercise interventions in patients with chronic musculoskeletal pain and that assessed pressure pain thresholds were considered.
METHODOLOGY: The Hartung-Knapp-Sidik-Jonkman random-effects method or Mantel-Haenszel fixed-effects method, depending on the heterogeneity, was applied to estimate the effects of exercise-induced hypoalgesia. The risk of bias was assessed with the risk of bias 2 tool and the certainty of the evidence was evaluated with Grading of Recommendations Assessment, Development, and Evaluation.
SYNTHESIS: Nineteen articles were included. The meta-analysis found a small statistically significant difference in favor of other physical therapy treatments compared with isolated exercise for pressure pain thresholds in both individuals with chronic neck-shoulder pain and those with chronic low back pain pain, with low and very low certainty of the evidence, respectively. For the overall risk of bias, 2 studies had a low risk, 6 had some concerns, and 11 had a high risk.
CONCLUSIONS: Isolated exercise in people with chronic neck and shoulder pain and those with chronic low back pain is not superior to other therapeutic modalities for improving pressure pain thresholds. Other physical therapy modalities generate higher pressure pain thresholds than isolated exercise with small effect size. These findings should be interpreted with caution due to the limited certainty of the evidence.
LITERATURE SURVEY: This systematic review and meta-analysis included a search of MEDLINE, Web of Science, CINAHL, SCOPUS, and EMBASE databases from inception until May 18, 2025. Randomized controlled trials that examined aerobic or anaerobic exercise interventions in patients with chronic musculoskeletal pain and that assessed pressure pain thresholds were considered.
METHODOLOGY: The Hartung-Knapp-Sidik-Jonkman random-effects method or Mantel-Haenszel fixed-effects method, depending on the heterogeneity, was applied to estimate the effects of exercise-induced hypoalgesia. The risk of bias was assessed with the risk of bias 2 tool and the certainty of the evidence was evaluated with Grading of Recommendations Assessment, Development, and Evaluation.
SYNTHESIS: Nineteen articles were included. The meta-analysis found a small statistically significant difference in favor of other physical therapy treatments compared with isolated exercise for pressure pain thresholds in both individuals with chronic neck-shoulder pain and those with chronic low back pain pain, with low and very low certainty of the evidence, respectively. For the overall risk of bias, 2 studies had a low risk, 6 had some concerns, and 11 had a high risk.
CONCLUSIONS: Isolated exercise in people with chronic neck and shoulder pain and those with chronic low back pain is not superior to other therapeutic modalities for improving pressure pain thresholds. Other physical therapy modalities generate higher pressure pain thresholds than isolated exercise with small effect size. These findings should be interpreted with caution due to the limited certainty of the evidence.