Impaired Exercise-induced Hypoalgesia in Individuals Reporting an Increase in Low Back Pain During Acute Exercise

HB Vaegter; Kristian Kjær Petersen; LV Sjodsholm; Pia Schou; Michael B. Andersen; Thomas Graven-Nielsen

doi:10.1002/ejp.1726

Impaired Exercise-induced Hypoalgesia in Individuals Reporting an Increase in Low Back Pain During Acute Exercise

HB Vaegter^*, Kristian Kjær Petersen, LV Sjodsholm, Pia Schou, Michael B. Andersen, Thomas Graven-Nielsen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

Objectives: Exercise therapy is recommended for low back pain (LBP) although the immediate effects on pain are highly variable. In 96 individuals with LBP this cross-sectional study explored (a) the magnitude of exercise-induced hypoalgesia (EIH) and (b) measures of pain sensitivity and clinical pain manifestations in individuals reporting a clinical relevant increase in back pain during physical activity compared with individuals reporting low or no increase in back pain during physical activity. Methods: Cuff algometry was performed at baseline on the leg to assess pressure pain threshold (cPPT), tolerance (cPTT) and temporal summation of pain (cTSP). Manual PPTs were assessed on the back and leg before and after a 6-min walk test (6MWT). Back pain was scored on a numerical rating scale (NRS) after each minute of walking. The EIH-effect was estimated as the increase in PPTs after the walk exercise. Results: Twenty-seven individuals reported an increase of ≥2/10 in pain NRS scores during walking and compared with the individuals with <2/10 NRS scores: cPPT and EIH-effects were lower whereas cTSP, pain intensity and disability were increased (p < 0.03). Baseline NRS scores, EIH and pain thresholds were associated with the likelihood of an increase of ≥2/10 in back pain intensity during walking (p < 0.05). Conclusions: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial EIH. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity. Significance: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial exercise-induced hypoalgesia. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity.

Original language	English
Journal	European Journal of Pain
Volume	25
Issue number	5
Pages (from-to)	1053-1063
Number of pages	11
ISSN	1090-3801
DOIs	https://doi.org/10.1002/ejp.1726
Publication status	Published - May 2021

Bibliographical note

HBV received funding from the Danish Rheumatism Association (R151-A4628). KKP is supported by the Aalborg University Talent Management Program (j.no. 771126). Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).

Keywords

exercise-induced hypoalgesia
pain sensitivity
pain threshold
pain tolerance
Physical activity
temporal summation of pain

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10.1002/ejp.1726

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title = "Impaired Exercise-induced Hypoalgesia in Individuals Reporting an Increase in Low Back Pain During Acute Exercise",

abstract = "Objectives: Exercise therapy is recommended for low back pain (LBP) although the immediate effects on pain are highly variable. In 96 individuals with LBP this cross-sectional study explored (a) the magnitude of exercise-induced hypoalgesia (EIH) and (b) measures of pain sensitivity and clinical pain manifestations in individuals reporting a clinical relevant increase in back pain during physical activity compared with individuals reporting low or no increase in back pain during physical activity. Methods: Cuff algometry was performed at baseline on the leg to assess pressure pain threshold (cPPT), tolerance (cPTT) and temporal summation of pain (cTSP). Manual PPTs were assessed on the back and leg before and after a 6-min walk test (6MWT). Back pain was scored on a numerical rating scale (NRS) after each minute of walking. The EIH-effect was estimated as the increase in PPTs after the walk exercise. Results: Twenty-seven individuals reported an increase of ≥2/10 in pain NRS scores during walking and compared with the individuals with <2/10 NRS scores: cPPT and EIH-effects were lower whereas cTSP, pain intensity and disability were increased (p < 0.03). Baseline NRS scores, EIH and pain thresholds were associated with the likelihood of an increase of ≥2/10 in back pain intensity during walking (p < 0.05). Conclusions: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial EIH. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity. Significance: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial exercise-induced hypoalgesia. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity.",

keywords = "exercise-induced hypoalgesia, pain sensitivity, pain threshold, pain tolerance, Physical activity, temporal summation of pain",

author = "HB Vaegter and Petersen, {Kristian Kj{\ae}r} and LV Sjodsholm and Pia Schou and Andersen, {Michael B.} and Thomas Graven-Nielsen",

note = "HBV received funding from the Danish Rheumatism Association (R151-A4628). KKP is supported by the Aalborg University Talent Management Program (j.no. 771126). Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).",

year = "2021",

month = may,

doi = "10.1002/ejp.1726",

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volume = "25",

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AU - Petersen, Kristian Kjær

AU - Sjodsholm, LV

AU - Schou, Pia

AU - Andersen, Michael B.

AU - Graven-Nielsen, Thomas

N1 - HBV received funding from the Danish Rheumatism Association (R151-A4628). KKP is supported by the Aalborg University Talent Management Program (j.no. 771126). Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).

PY - 2021/5

Y1 - 2021/5

N2 - Objectives: Exercise therapy is recommended for low back pain (LBP) although the immediate effects on pain are highly variable. In 96 individuals with LBP this cross-sectional study explored (a) the magnitude of exercise-induced hypoalgesia (EIH) and (b) measures of pain sensitivity and clinical pain manifestations in individuals reporting a clinical relevant increase in back pain during physical activity compared with individuals reporting low or no increase in back pain during physical activity. Methods: Cuff algometry was performed at baseline on the leg to assess pressure pain threshold (cPPT), tolerance (cPTT) and temporal summation of pain (cTSP). Manual PPTs were assessed on the back and leg before and after a 6-min walk test (6MWT). Back pain was scored on a numerical rating scale (NRS) after each minute of walking. The EIH-effect was estimated as the increase in PPTs after the walk exercise. Results: Twenty-seven individuals reported an increase of ≥2/10 in pain NRS scores during walking and compared with the individuals with <2/10 NRS scores: cPPT and EIH-effects were lower whereas cTSP, pain intensity and disability were increased (p < 0.03). Baseline NRS scores, EIH and pain thresholds were associated with the likelihood of an increase of ≥2/10 in back pain intensity during walking (p < 0.05). Conclusions: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial EIH. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity. Significance: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial exercise-induced hypoalgesia. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity.

AB - Objectives: Exercise therapy is recommended for low back pain (LBP) although the immediate effects on pain are highly variable. In 96 individuals with LBP this cross-sectional study explored (a) the magnitude of exercise-induced hypoalgesia (EIH) and (b) measures of pain sensitivity and clinical pain manifestations in individuals reporting a clinical relevant increase in back pain during physical activity compared with individuals reporting low or no increase in back pain during physical activity. Methods: Cuff algometry was performed at baseline on the leg to assess pressure pain threshold (cPPT), tolerance (cPTT) and temporal summation of pain (cTSP). Manual PPTs were assessed on the back and leg before and after a 6-min walk test (6MWT). Back pain was scored on a numerical rating scale (NRS) after each minute of walking. The EIH-effect was estimated as the increase in PPTs after the walk exercise. Results: Twenty-seven individuals reported an increase of ≥2/10 in pain NRS scores during walking and compared with the individuals with <2/10 NRS scores: cPPT and EIH-effects were lower whereas cTSP, pain intensity and disability were increased (p < 0.03). Baseline NRS scores, EIH and pain thresholds were associated with the likelihood of an increase of ≥2/10 in back pain intensity during walking (p < 0.05). Conclusions: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial EIH. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity. Significance: Pain flares in response to physical activity in individuals with LBP seem to be linked with baseline pain sensitivity and pain intensity, and impair the beneficial exercise-induced hypoalgesia. Such information may better inform when individuals with LBP will have a beneficial effect of physical activity.

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Impaired Exercise-induced Hypoalgesia in Individuals Reporting an Increase in Low Back Pain During Acute Exercise

Abstract

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Keywords

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