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Is Aerobic Exercise Useful to Manage Chronic Pain? Exercício Aeróbico Ajuda No Tratamento Da Dor Crônica?

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Is Aerobic Exercise Useful to Manage Chronic Pain? Exercício Aeróbico Ajuda No Tratamento Da Dor Crônica? Rev Dor. São Paulo, 2016 jan-mar;17(1):61-4 REVIEW ARTICLE Is aerobic exercise useful to manage chronic pain? Exercício aeróbico ajuda no tratamento da dor crônica? Carolina Ortigosa Cunha1, Lívia Maria Sales Pinto-Fiamengui2, Fernanda Araújo Sampaio3, Paulo César Rodrigues Conti3 DOI 10.5935/1806-0013.20160015 ABSTRACT RESUMO BACKGROUND AND OBJECTIVES: Several studies have JUSTIFICATIVA E OBJETIVOS: Vários estudos têm demons- shown the importance of biopsychosocial strategies, including trado a importância de utilização de estratégias biopsicossociais, pharmacological and non-pharmacological therapies, to decrease incluindo terapias farmacológicas e não farmacológicas, para re- pain in orofacial pain patients. The involvement of pain modula- duzir a dor em pacientes com dor orofacial. O envolvimento da tion during aerobic exercise contributes to the use of such moda- modulação da dor durante o exercício aeróbico contribui para o lity as part of rehabilitation programs for chronic pain patients. uso dessa modalidade como parte de programas de reabilitação Studies have shown that aerobic exercise may increase the level para pacientes com dor crônica. Estudos demonstram que o exer- of several neurotransmitters, such as serotonin, dopamine, ace- cício aeróbico pode aumentar o nível de vários neurotransmisso- tylcholine and norepinephrine. The reality is that it activates en- res tais como serotonina, dopamina, acetilcolina e norepinefrina. docannabinoid and endogenous opioid systems, involved in pain A realidade é que ele ativa os sistemas endocanabinóide e opioide modulation. The effect of physical activity on pain perception endógeno, envolvidos no sistema de modulação de dor. O efeito is often called exercise-induced hypoalgesia. This study aimed da atividade física na percepção da dor é comumente denomi- at discussing the use of exercise-induced hypoalgesia as part of nado hipoalgesia induzida por exercício. O objetivo deste estu- chronic pain management, including orofacial pain. do foi discutir o uso do fenômeno da hipoalgesia induzida por CONTENTS: Comprehensive search on Pubmed, Medline, exercício como parte do tratamento da dor crônica, incluindo a Web of Science and Scopus databases was carried out using the dor orofacial. keywords: physical exercise, aerobic exercise, exercise-induced CONTEÚDO: Pesquisas abrangentes na base de dados Pubmed, hypoalgesia, exercise-induced analgesia and orofacial pain/chro- Medline, Web of Science e Scopus foram realizadas utilizando as nic orofacial pain. palavras-chave: exercício físico, exercício aeróbico, hipoalgesia CONCLUSION: Exercise does not need to be of high-intensity induzida por exercício, analgesia induzida por exercício e dor to have an effect on pain management. Although there is evi- orofacial/dor orofacial crônica. dence that some chronic pain patients may have the capacity to CONCLUSÃO: O exercício não precisa ser de alta intensidade exercise at intensities and durations that appear to be required to para se obter efeito sobre o controle da dor. Embora alguns estudos elicit exercise-induced hypoalgesia in healthy subjects, the exerci- comprovem que alguns pacientes com dor crônica tem a capaci- se tolerance of other unhealthy populations requires study. Addi- dade de se exercitarem em intensidades e durações de exercício tional research is needed to clarify and expand the understanding que induzem a hipoalgesia induzida por exercício, a tolerância ao of the mechanisms responsible for exercise-induced hypoalgesia exercício e seus efeitos em populações de pacientes crônicos ain- and how it can be used in chronic pain conditions such as chro- nic orofacial pain. da exigem mais estudos e investigações para esclarecer e ampliar a Keywords: Chronic pain, Exercise, Exercise therapy, Orofacial compreensão do mecanismo da hipoalgesia induzida por exercício. pain, Pain management. Descritores: Dor crônica, Dor orofacial, Exercício, Manuseio da dor, Terapia por exercício. INTRODUCTION 1. Universidade do Sagrado Coração, Faculdade de Odontologia, Bauru, SP, Brasil. According to the International Association for the Study of Pain 2. Christus Centro Universitário, Faculdade de Odontologia, Fortaleza, CE, Brasil. 3. Universidade de São Paulo, Faculdade de Odontologia, Departamento de Prótese Den- (IASP), pain is an unpleasant sensory and emotional experience tária, Bauru, SP, Brasil. associated with actual or potential tissue damage, or described in Submitted in November 30, 2015. terms of such damage. It is always subjective once it is an emotional Accepted for publication in January 23, 2016. experience related to injuries in early life. Conflict of interests: none – Sponsoring sources: none. Pain may follow either acute or chronic course1. Iadarola and Cau- Correspondência to: dle2, stated that the acute pain, classified as “good” pain, has an im- Carolina Ortigosa Cunha Rua Irmã Arminda, 10-50 - Jardim Brasil portant protective function for the organism. When this pain turns 17011-160 Bauru, SP, Brasil. to chronic it is considered “bad pain” since no longer has the pro- E-mail: [email protected] tective effect. Patients who suffer with chronic pain usually have an © Sociedade Brasileira para o Estudo da Dor altered function of the central nervous system (CNS) that happens 61 Rev Dor. São Paulo, 2016 jan-mar;17(1):61-4 Cunha CO, Pinto-Fiamengui LM, Sampaio FA and Conti PC as result of persistent pathology or neuroplasticity changes3. There- mitters) as inhibitory mediators. As the nociceptive signal stimulates fore, chronic pain is considered as a disease itself. According to IASP, higher brainstem centers, it is modulated by inhibitory pathways it is the pain that persists past the healing phase following an injury. that send signals downstream reducing the strength of the pain sig- Chronic pain is associated with emotional and behavioral changes of nal or if not completely eliminating it18. the individual that suffers with it. Therefore, in order to have a better Nowadays, aerobic exercise is part of the non-pharmacological ap- outcome, pain physicians should include the management of these proach in patients with chronic musculoskeletal orofacial pain19. Ae- aspects during chronic pain treatment. robic exercise programs reduce pain, fatigue and depression, and im- Long-term conditions, such as chronic pain, result in psychological prove peak oxygen uptake, health-related quality of life and physical morbidity and impaired quality of life4. Pain modulation is part of fitness in patients with fibromyalgia20,21. In chronic low back pain, the normal function of CNS, where the pain signal can be enhan- aerobic endurance exercises are also commonly used and have been ced, inhibited or may remain the same at the brainstem level. When shown to reduce pain perception22. Even for migraine, exercise can persistent nociceptive facilitation exceeds the inhibitory capacity, improve pharmacological treatment. A recent study evaluated the neuroplastic changes can occur peripherally or centrally and are association of amitriptyline and aerobic exercise for the treatment of known as peripheral sensitization and central sensitization, respec- sixty patients diagnosed with chronic migraine. In the aerobic exer- tively5. CNS alterations, such as central sensitization and impaired cise program patients were instructed to perform a 40 minutes fast descending modulatory mechanisms, contribute to the difficulties walk outdoors with a frequency of 3 times/week for 12 consecutive in chronic pain management. weeks. The combination of amitriptyline and aerobic exercise was Several studies have shown the importance of biopsychosocial ma- associated with an even greater reduction in the frequency, duration nagement strategies, including pharmacological and non-pharma- and intensity of headache23. cological therapies, to reduce pain and improve function in orofacial Studies have shown EIH (increased pain thresholds) after aerobic pain patients6. However, there is a lack of real breakthrough innova- exercise for both mechanical 22,24,25 and thermal stimuli26 and genera- tion in the field of pain management over the past years7. According lized increase of pressure pain thresholds following isometric muscle to Turk, Wilson and Cahana7, although there are massive efforts contraction24,27. coming from basic science and clinical research to improve pain ma- Koltyn13 published a review article about analgesia following exer- nagement, it remains a clinical challenge. cise describing the effect in animals and humans. According to the Exercise to reduce pain has been reported in the literature since the author, studies of exercise and analgesia started when researches ob- early 1980s8-14 and the effect of physical activity on pain perception served that dancers and athletes could continue strenuous exercise is commonly termed as exercise-induced hypoalgesia (EIH)8. It has in face of severe injuries, and later reported that they felt no pain. It been shown that aerobic exercise may increase or optimize the levels has contributed to the notion that exercise can alter pain perception. of several neurotransmitters such as serotonin, dopamine, acetylcho- Animal studies have shown the phenomenon of analgesia following line and norepinephrine. Indeed, it activates the endocannabinoid exercise and the involvement of the endogenous opioid system. In and endogenous opioid systems15,16. Conditioned pain modulation the above-mentioned review, Koltyn observed that most researches (CPM) is another potential factor that
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