Pain: Why and how it hurts

Exercise is commonly used as a treatment technique in sports medicine for musculoskeletal pain. A recent meta-analysis has examined the effects of exercise-induced hypoalgesia on healthy and chronic pain populations.1 This study found that isometric, aerobic and dynamic resistance exercises reduced the perception of experimentally induced pain in healthy participants. However in the study’s chronic pain population (including fibromyalgia syndrome, chronic fatigue syndrome, chronic low back pain, chronic musculoskeletal pain and shoulder myalgia) the perception of experimentally induced pain (not pre-existing pain complaint) after exercise was inconsistent. Generally, when exercises were performed using body parts away from the painful area, the perception of pain intensity was reduced.

The meta-analysis also found that in some individuals with widespread pain presentations, moderate to high intensity exercise could lead to exacerbation of pain scores.

Photo: familymwr. Used with permission. All rights reserved.
Source: flickr

Unfortunately recommendations on specific exercise parameters could not be deduced due to the variability in exercise prescriptions. These findings highlight the importance of continually monitoring and reassessing prescribed treatment exercises, particularly in widespread pain presentations.

Our understanding of pain and why and how it hurts has come a long way in the last decade. So it is quite timely that the pain chapter in the Clinical Sports Medicine textbook has been given a complete overhaul in its fourth edition (Pain: Why and how it hurts: Chapter 6). Nowadays clinical assessments should ideally address not only the sensory pain outcomes but also acknowledge the individual’s emotional responses to their pain. This is reinforced by chapter six which describes pain as ‘… an unpleasant sensory and emotional experience that is felt in the body and that motivates us to do something to escape it.’

Clinical and research physiotherapist and leading expert in the field of pain science, Professor Lorimer Mosely co-authors chapter 6 and provides valuable insight into the current understanding of pain. Professor Moseley has published over 100 papers, three books and has presented over 120 keynote presentations on pain in humans all over the world. His research focuses on the role of the brain and mind in chronic pain. Understanding the role of the central nervous system (brain and spinal cord) in pain presentations is an essential part of a clinician’s overall understanding of the clinical presentation of a person with pain.


1. Naugle KM, Fillingim RB, Riley JL, 3rd. A meta-analytic review of the hypoalgesic effects of exercise. The journal of pain 2012 13(12): 1139-50

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