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Effects of Exercise Therapy on Endogenous Pain-relieving Peptides in Musculoskeletal Pain: A Systematic Review

Fuentes C, Jorge P. Bsc PT, MSc RS*,†,‡; Armijo-Olivo, Susan MSc, PhD*,§; Magee, David J. PhD; Gross, Douglas P. PhD

The Clinical Journal of Pain: May 2011 - Volume 27 - Issue 4 - p 365–374
doi: 10.1097/AJP.0b013e31820d99c8
Review Article

Objective To review the literature regarding the effects of exercise in patients with musculoskeletal pain on modifying: (1) the plasma or cerebral spinal fluid concentrations of pain-relieving peptides and (2) changing the cerebral activity of areas linked with pain processing and modulation systematically.

Methods An extensive search of bibliographic databases including MEDLINE, EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, ISI Web of Science, Scopus, PeDro, AMED, and CINAHL was made. Two independent investigators screened the titles of publications and completed quality assessment of the selected studies.

Results The search of the literature resulted in a total of 1819 published studies. Of these only 1 study of low methodological quality was considered to be relevant. The agreement between reviewers to select the articles was κ=1. The agreement for the methodological quality evaluation was κ=0.9.

Discussion Given the small number of studies identified and the low quality of research, no firm conclusions could be reached about the impact of therapeutic exercise on modifying concentrations of pain-relieving peptides or its effect on changing the cerebral activity of areas linked with pain processing in patients with musculoskeletal pain. There is a clear need for well-designed trials examining exercise therapy interventions and their effect on both pain-relieving peptides and cerebral activity in patients with musculoskeletal pain.

Department of Physical Therapy

Rehab Research Centre

*Faculty of Rehabilitation Medicine

§Alberta Research Centre for Health Evidence (ARCHE) Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada

Department of Physical Therapy, Catholic University of Maule, Talca, Chile

Support was provided from the following agencies: Alberta Provincial CIHR Training Program in Bone and Joint Health (Alberta, Canada), Izaak Walton Killam scholarship from the University of Alberta (Alberta, Canada), Canadian Institutes of Health Research (Canada), Government of Chile (MECESUP Program), University Catholic of Maule (Talca, Chile), and Physiotherapy Foundation of Canada through an Ann Collins Whitmore Memorial Award (Alberta, Canada).

Reprints: Jorge P. Fuentes C, Bsc PT, MSc RS, Faculty of Rehabilitation Medicine, University of Alberta, 3-50 Corbett Hall, Alberta, Canada T6G 2G4 and Department of Physical Therapy, Catholic University of Maule, Talca, Chile (e-mail:

Received October 6, 2009

Accepted December 28, 2010

© 2011 Lippincott Williams & Wilkins, Inc.