Evidence for physical activity in treatment of adult patients with chronic low back or neck pain - a systematic literature study

Abstract

BACKGROUND. Chronic primary pain has been recognized as a disease by WHO (World Health Organization). The definition of chronic pain is pain that lasts or recurs for longer than three months. In Sweden physical exercise has a major part in the rehabilitation of chronic pain. AIM. To investigate the current evidence for physical activity as treatment in adult patients with chronic low back or neck pain. METHODS A systematic search in five databases for systematic reviews with or without meta-analysis, published between 2017- January 2021, was conducted. A systematic screening strategy, the PICO model, was used to limit the search. RESULTS. Out of 781 articles, 8 systematic reviews were selected for synthesis (chronic low back pain n=5; chronic neck pain n= 3). There is low to moderate evidence that physical exercise (both mindful exercises and aerobic exercises) improves disability and gives pain relief in patients with low back pain at <3-6 months follow-up. There is limited to low evidence that physical exercise improves disability and gives pain relief in patients with chronic neck pain at <3-6 months follow-up. There is moderate evidence that physical exercise compared to nonactive control had no effect on pain relief or disability at long-term follow-up (≥12 months) in neither of the patient groups. No serious adverse events from using the physical interventions investigated were found. CONCLUSION. Physical exercise is effective for pain relief and disability in the rehabilitation of patients with chronic low back pain and chronic neck pain in <3- 6 months. However, at ≥12 months of follow-up, there was no difference between the exercise intervention group and the non-active group in neither pain relief nor disability. Physical exercise is not associated with any serious adverse events.