title: Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena.
abstract: Exercise is an integral part of the rehabilitation of patients suffering a variety of chronic musculoskeletal conditions, such as fibromyalgia, chronic low back pain and myofascial pain. Regular physical activity is recommended for treatment of chronic pain and its effectiveness has been established in clinical trials for people with a variety of pain conditions. However, exercise can also increase pain making participation in rehabilitation challenging for the person with pain. Animal models of exercise-induced pain have been developed and point to central mechanisms underlying this phenomena, such as increased activation of NMDA receptors in pain-modulating areas. Meanwhile, a variety of basic science studies testing different exercise protocols, show exercise-induced analgesia involves activation of central inhibitory pathways. Opioid, serotonin and NMDA mechanisms acting in rostral ventromedial medulla promote analgesia associated with exercise. This review explores and discusses current evidence on central mechanisms underlying exercised-induced pain and analgesia.
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, Iowa City, IA, 52242, USA.
authors.forename: Lucas V
authors.identifier: 0000-0002-1282-0511
authors.initials: LV
authors.lastname: Lima
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, Iowa City, IA, 52242, USA.
authors.forename: Thiago S S
authors.identifier: 0000-0001-9653-3116
authors.initials: TSS
authors.lastname: Abner
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, Iowa City, IA, 52242, USA.
authors.forename: Kathleen A
authors.identifier: 0000-0003-0207-8728
authors.initials: KA
authors.lastname: Sluka
mesh_terms: D000818:Animals; D002490:Central Nervous System / Q000378:metabolism / Q000502:physiology*; D015444:Exercise; D006801:Humans; D059225:Nociception; D010146:Pain / Q000378:metabolism* / Q000503:physiopathology; D010805:Physical Conditioning, Animal
keywords: animal; central nervous system; exercise; glutamate; hyperalgesia; opioid; pain; physical activity; serotonin