• Ferro Moura Franco Katherinne K 0000-0002-9269-5350 Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Br, Dorine Lenoir, Dos Santos Franco Yuri Rafael YR 0000-0003-4510-7680 Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, B, Jandre Reis Felipe José FJ 0000-0002-9471-1174 Pain in Motion International Research Group, Brussels, Belgium. , Nunes Cabral Cristina Maria CM 0000-0002-9445-3152 Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Bra, and Mira Meeus.
• Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
• Eur J Pain. 2021 Jan 1; 25 (1): 51-70.

Background And ObjectiveTo compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash-associated disorders (CWAD), and chronic idiopathic neck pain (CINP).Databases And Data TreatmentRandomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis.ResultsFifty studies with 3,562 participants were included. For fibromyalgia, both aerobic strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50- to 60-min supervised sessions, 2 to 3 times a week, for 13 weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90-min supervised sessions, twice a week, for 10 to 16 weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30- to 60-min supervised sessions, 2 to 3 times a week, for 7 to 12 weeks.ConclusionsThe choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non-nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills.Prospero Registration NumberCRD42019123271.SignificanceThe pain mechanism must be considered to optimize exercise prescription in patients with different chronic pain profiles. The main message of this article is that low to moderate intensity global exercises performed for a long period of treatment should be performed in patients with nociplastic pain predominance. Additionally, focused and intense exercises for a short period of treatment can be prescribed for patients with nociceptive pain predominance.© 2020 European Pain Federation - EFIC®.

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