Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus

Author: Yong-Hui Zhang1, Hao-Yu Hu1,2, Yuan-Chang Xiong3, Changgeng Peng4, Li Hu5, Ya-Zhuo Kong5, Yu-Ling Wang6, Jia-Bao Guo7, Sheng Bi8, Tie-Shan Li9, Li-Juan Ao10, Chu-Huai Wang11, Yu-Long Bai12, Lei Fang13, Chao Ma14, Lin-Rong Liao15, Hao Liu15, Yi Zhu16, Zhi-Jie Zhang17, Chun-Long Liu18, Guo-En Fang19, Xue-Qiang Wang1,2
1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
2 Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China.
3 Department of Pain Therapy, First Affiliated Hospital of Naval Medical University, Shanghai, China.
4 The First Rehabilitation Hospital of Shanghai, Brain and Spinal Cord Innovation Research Center, School of Medicine, Advanced Institute of Translational Medicine, Tongji University, Shanghai, China.
5 Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
6 Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
7 The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, China.
8 Rehabilitation Medicine Centre, Chinese PLA General Hospital, Beijing, China.
9 Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
10 School of Rehabilitation, Kunming Medical University, Kunming, China.
11 Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
12 Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.
13 School of Rehabilitation Science, Shanghai University of T.C.M., Shanghai, China.
14 Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
15 Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China.
16 Department of Pain and Musculoskeletal Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
17 Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China.
18 Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
19 Department of Gastrointestinal Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China.
Conference/Journal: Front Med (Lausanne)
Date published: 2021 Nov 24
Other: Volume ID: 8 , Pages: 756940 , Special Notes: doi: 10.3389/fmed.2021.756940. , Word Count: 357

Background: Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines. Design: A systematic review and expert consensus. Methods: A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine. Results: Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga). Conclusions: Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five-ten years.

Keywords: chronic pain; exercise; expert consensus; neuropathic pain; training.

PMID: 34901069 PMCID: PMC8654102 DOI: 10.3389/fmed.2021.756940