Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-analysis

Background Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effect...

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Bibliographic Details
Published in:Sports medicine (Auckland) 2022-04, Vol.52 (4), p.789-816
Main Authors: Miller, Clint T., Owen, Patrick J., Than, Christian A., Ball, Jake, Sadler, Kate, Piedimonte, Alessandro, Benedetti, Fabrizio, Belavy, Daniel L.
Format: Article
Language:English
Subjects:
Adult
Adults
Arthritis
Chronic pain
Chronic Pain - therapy
Clinical medicine
Clinical trials
Exercise Therapy
Fitness training programs
Humans
Intervention
Medicine
Medicine & Public Health
Meta-analysis
Musculoskeletal diseases
Musculoskeletal Pain - therapy
Natural history
Osteoarthritis
Pain
Patients
Physical training
Placebo Effect
Placebos
Reviews
Sports Medicine
Systematic Review
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Summary:Background Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. Design Systematic review with meta-analysis Data Sources MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. Eligibility Criteria Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). Results We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo ( g [95% CI]: 0.94 [− 0.17, 2.06], P  = 0.098, I 2  = 92.46%, studies: n  = 4). Exercise training was more effective than true, no intervention controls ( g [95% CI]: 0.99 [0.66, 1.32], P  
ISSN:0112-1642
1179-2035
DOI:10.1007/s40279-021-01526-6