Impaired exercise-induced hypoalgesia in individuals reporting an increase in low back pain during acute exercise

Review written by Dr Sandy Hilton info

Key Points

  1. The response to exercise is less consistent in individuals with low back pain compared to pain-free individuals.
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BACKGROUND & OBJECTIVE

Research over the last decade into individual differences in the magnitude of clinical symptoms in low back pain (LBP) has focused on mechanisms that control the modification of nociception. People with LBP have more sensitivity to temporal summation of pain (TSP) and decreased/impaired conditioned pain modulation (CPM) (1). They are more likely to hurt in response to a stimulus and are less able to modify the pain response than healthy controls.

Exercise is a common intervention for LBP and healthy individuals typically experience positive outcomes including a reduction in pain sensitivity after as little as a single exercise session (2). This is referred to as exercise-induced hypoalgesia (EIH). There is significant variability between individuals of EIH, including some who respond to exercise with reduced EIH, or even hyperalgesia (3).

The primary aim of this study was to explore the differences in EIH, performance, pain sensitivity, and pain characteristics between individuals with LBP that reported an increase in pain of 2/10 or higher with walking, and those who did not have an increase in pain reaching 2/10 with walking.

People with LBP have more sensitivity to temporal summation of pain and decreased/impaired conditioned pain modulation.
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If pain flares can be predicted through assessment of baseline sensitivity, we may be able to use this to better design exercise programs for those with persistent pain.

METHODS

This paper was a cross-sectional study with 96 individuals who were referred with LBP to the rehabilitation center. They were all scheduled to participate in an 8-week group exercise program. All participants completed the intake questionnaires and baseline pressure pain

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