Kinesiophobia is associated with pain intensity but not pain sensitivity before and after exercise: an explorative analysis

Objective: To compare clinical pain intensity, exercise performance, pain sensitivity and the effect of aerobic and isometric exercise on local and remote pressure pain thresholds (PPTs) in patients with chronic musculoskeletal pain with high and low levels of kinesiophobia. Design: An experimental pre–post within-subject study. Setting: An exercise laboratory in a multidisciplinary pain clinic. Participants: Fifty-four patients with chronic musculoskeletal pain. Interventions: Acute aerobic and isometric leg exercises. Main outcome measures: Clinical pain intensity (numerical rating scale, range 0 to 10), Tampa Scale of Kinesiophobia, aerobic and isometric exercise performances (intensity and maximal voluntary contraction), and PPTs at local and remote body areas before and after exercise conditions. Results: Patients with a high degree of kinesiophobia demonstrated increased pain intensity compared with patients with a low degree of kinesiophobia [high degree of kinesiophobia: 7.3 (1.6) on NRS; low degree of kinesiophobia: 6.3 (1.6) on NRS; mean difference 1.0 (95% confidence interval 0.08 to 1.9) on NRS]. Aerobic and isometric exercises increased PPTs, but no significant group differences were found in PPTs before and after exercise. Conclusions: Clinical pain intensity was significantly higher in patients with a high degree of kinesiophobia compared with patients with a low degree of kinesiophobia. Despite a difference in isometric exercise performance, the hypoalgesic responses after cycling and isometric knee exercise were comparable between patients with high and low degrees of kinesiophobia. If replicated in larger studies, these findings indicate that although kinesiophobic beliefs influence pain intensity, they do not significantly influence PPTs and exercise-induced hypoalgesia in patients with chronic musculoskeletal pain.