Physical Exercise for Chronic Pain: Why It Helps and When to Use It
Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 2015;29(1):120–130. doi:10.1016/j.berh.2015.04.022
Background
Chronic pain is one of the most widespread and disabling health challenges globally, affecting over 100 million Americans and significantly more worldwide. Its consequences extend beyond physical discomfort; often impacting sleep, mental health, work participation, and overall quality of life. While medications remain a standard intervention, they can pose serious risks, including side effects, dependency, and limited long-term benefit.
In response, physical therapists and healthcare professionals have increasingly emphasized non-pharmacological treatments like exercise. This review article explores how physical activity can influence chronic pain across various systems and highlights when and how to best introduce movement to support long-term recovery.
What Question Is the Study Trying to Answer?
The authors explore two main questions:
Why is physical exercise an effective non-pharmacological strategy for managing chronic pain?
When is it appropriate to introduce exercise into a patient’s care plan, especially for those with high sensitivity or comorbid conditions?
The goal is to synthesize research on the mechanisms, outcomes, and barriers associated with exercise as a pain management tool.
Who Was in the Study and What Were the Groups?
This was not a clinical trial but rather a narrative literature review, meaning the authors did not recruit study participants or compare test groups directly. Instead, they synthesized and evaluated research findings from a broad body of existing literature. The types of studies included:
Randomized controlled trials (RCTs)
Systematic reviews and meta-analyses
Practice guidelines and consensus statements
Observational cohort studies
The review focused on research involving patients with:
Osteoarthritis
Chronic low back pain
Fibromyalgia
Neuropathic pain
Generalized chronic musculoskeletal pain
While these conditions differ in pathology, they share common features such as impaired function, persistent discomfort, central sensitization, and high rates of medication use. The authors use this overlap to highlight broad principles of exercise application that may benefit a wide range of patients.
They also discussed patient subgroups that may respond differently depending on age, physical deconditioning, baseline fitness, and psychosocial factors such as fear-avoidance beliefs or depression.
What Did the Study Find?
The authors outline compelling evidence that physical activity can mitigate chronic pain and improve functional outcomes, provided it is implemented appropriately. Major findings include:
Consistent Pain Reduction: Exercise reduces pain in many chronic conditions, even when structural damage or disease processes remain unchanged. Pain improvements are not always immediate, but they tend to accumulate over time with consistent participation.
Enhanced Physical Function: Improvements in strength, joint mobility, posture, and endurance help patients return to meaningful activities like walking, caregiving, or recreational pursuits. These functional gains often correspond with improved confidence and quality of life.
Central Mechanisms of Pain Relief: Chronic pain is often maintained by central sensitization—a heightened nervous system response to stimuli. Exercise has been shown to decrease this sensitivity by modulating descending inhibitory pathways and increasing endorphin activity.
Reduced Inflammation: Moderate aerobic exercise can dampen pro-inflammatory cytokine activity and enhance anti-inflammatory profiles. This systemic effect is particularly valuable for patients with arthritis, metabolic syndrome, or obesity-related pain.
Mood and Self-Efficacy: Chronic pain often leads to psychological distress, which can further exacerbate symptoms. Exercise improves mood, reduces anxiety, and enhances self-efficacy, helping patients feel more in control of their condition.
Timing of Intervention: Introducing exercise early in the management plan—before deconditioning sets in—is ideal. However, even patients with longstanding pain can benefit if programming is adapted to their limitations and paced appropriately.
Flexible Modalities: No single type of exercise is universally superior. Programs may include walking, aquatic therapy, yoga, Pilates, cycling, resistance training, or Tai Chi. The key is tailoring mode and intensity to the individual.
Real-World Barriers: Many patients fear that movement will worsen their symptoms. Others struggle with motivation, access, or lack of support. Addressing these barriers through education, graded exposure, and collaborative goal setting is crucial for long-term success.
What Are the Potential Limitations of the Study?
As a narrative review, this article doesn’t provide new experimental data and may be subject to selection bias in study inclusion.
While the article cites evidence from RCTs, it doesn’t systematically rate the quality of each included study.
There’s limited specificity about dosage, frequency, or exact exercise prescription that might be most effective.
It focuses more on general trends and implications than on condition-specific treatment pathways.
What Does This Mean for You as a Patient?
For anyone living with chronic pain, this research reinforces a hopeful message: physical activity is one of the most effective treatments available—without the risks of medication. But more importantly, it doesn’t require extreme effort or traditional fitness routines.
Even low-intensity activity like walking, stretching, or gentle resistance training can create meaningful changes in your nervous system, inflammation levels, and mental health. Many patients worry that movement will make pain worse, but research shows the opposite: progressive, well-paced exercise can reduce pain over time and increase your ability to engage in life again.
If you’ve been avoiding movement due to fear or previous setbacks, this is a strong reason to work with a provider who understands how to customize a program for your needs. Starting small—and building slowly—can help you reclaim mobility, confidence, and control.
Final Thoughts
Movement doesn’t have to hurt to help. Exercise is a versatile, powerful, and evidence-based treatment that supports recovery across body and mind. This review adds to the growing body of evidence that motion is medicine, and physical activity should be a frontline therapy for most chronic pain conditions.
If you’re unsure how or where to begin, talk to a physical therapist. Together, you can build a program that meets you where you are and helps you move toward lasting relief.
Reference
Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 2015;29(1):120–130. doi:10.1016/j.berh.2015.04.022
