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Phys Med Rehabil Clin N Am. 2015 May;26(2):263-81. doi: 10.1016/j.pmr.2014.12.007. Epub 2015 Feb 21.

Exercise therapy for chronic pain.

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Rehabilitation Institute of Washington, PLLC, 415 1st Ave N, Ste 200, Seattle, WA 98109, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, 325 9th Ave, Box 359612, Seattle, WA 98104, USA. Electronic address:


The benefit of exercise for pain control likely comes from the impact of exercise on the endogenous opioid system and on central pain modulatory systems. Patients with some chronic pain conditions seem to have a dysfunctional endogenous pain modulatory system, which should be considered when prescribing exercise. The prescription of exercise for chronic pain must address the biomechanical issues and the psychosocial factors that contribute to the patient's pain and disability. Patient education, coordination of care within the health care team, and selecting an exercise regimen that is meaningful to and achievable by the patient are all important components to promote a successful rehabilitation program.


Chronic pain; Endogenous pain modulation; Exercise; Fear-avoidance; Neuroscience education; Physical therapy

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