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Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-analysis
Clint T Miller1, Patrick J Owen2, Christian A Than3
1Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia. c.miller@deakin.edu.au.
Sports Medicine (Auckland, N.Z.)
|August 28, 2021
Summary
Exercise training shows no significant pain reduction benefit over placebo for chronic musculoskeletal pain. However, it is more effective than no intervention or usual care, suggesting non-specific effects contribute to pain relief.
Area of Science:
- Musculoskeletal Health
- Pain Management
- Exercise Science
Background:
- Chronic musculoskeletal pain significantly impacts quality of life.
- Exercise is a common treatment, but its specific benefits versus placebo and non-specific effects are unclear.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of exercise training for chronic primary musculoskeletal pain.
- To differentiate the specific effects of exercise from placebo and non-specific effects.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched MEDLINE, CINAHL, SPORTDiscus, EMBASE, and CENTRAL databases.
- Included trials comparing exercise to placebo, true control, or usual care.
Main Results:
- Exercise training was not more effective than placebo (very low-quality evidence).
- Exercise training demonstrated effectiveness compared to true controls, usual care, and all controls combined.
- Significant heterogeneity was observed across studies.
Conclusions:
- Very low-quality evidence suggests exercise training offers no superior pain reduction compared to non-exercise placebo treatments.
- Exercise, including the clinical encounter, provides greater pain reduction than true control or standard care for chronic musculoskeletal pain.
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