Review article (meta-analysis)
Effectiveness of Exercise Interventions for Pain Reduction in People With Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Abstract

Objective

To systematically review the evidence of the effect of exercise compared with passive control on pain in people with multiple sclerosis.

Data Source and Study Selection

Five electronic databases were searched for randomized controlled trials published up to March 2017 that recruited people with multiple sclerosis where exercise was the intervention and pain was an outcome (PROSPERO registration number CRD42017060489).

Statistical Analysis

A random-effects meta-analysis was conducted to estimate the standardized mean difference of the effect of exercise on pain between treatment and control groups. We assessed risk of bias, fitted meta-regression models to explore heterogeneity between studies, and assessed small study effects.

Data Synthesis

Ten studies met the inclusion criteria (total sample size=389), and all studies were at high risk of bias. We found that exercise interventions were associated with less pain compared with passive control groups (standardized mean difference=−.46; 95% CI, −.92 to .00). There was high between-study heterogeneity (I2=77.0%), which was not explained by the prespecified study characteristics. There was also some evidence of small study effects.

Conclusion

This is the first systematic review of the effect of exercise interventions on pain in people with multiple sclerosis, a chronic neurological disorder that affects 2.5 million people. We found some evidence that exercise compared with passive control alleviates pain in this population, but there were limitations in reporting and study quality with high risk of bias of individual studies and heterogeneity between studies.

Section snippets

Pain in multiple sclerosis

Up to 85%7, 8, 9, 10, 11 of people with MS (PwMS) report pain, with 30% describing it as the most severe symptom.7, 12 Pain affects both physical capability and psychological aspects of life.9, 13, 14 PwMS experiencing pain tend to reduce physical activity, leading to muscle stiffness, weakness, and deconditioning that subsequently increases pain15, 16 and increases risk for comorbidities such as heart disease, hypertension, and diabetes.17 Pain often leads to increased anxiety, stress, anger,

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement47 (appendix 1). The review protocol was developed prior to the start of the literature search and registered with the International Prospective Register of Systematic Reviews (registration number CRD42017060489).48

Study selection

A total of 332 articles were identified through the database search (fig 1). After removing duplicates, 210 studies were available. Of these, 190 articles were excluded based on their title and abstracts, leaving 20 potentially relevant articles. After full text screening, 10 studies were excluded; the majority of the excluded studies either did not measure pain or did not report pain as a primary or secondary outcome in the results. One study aimed to promote physical activity using a

Summary of evidence

Our systematic review and meta-analysis of 10 RCTs provides some evidence that exercise may help to decrease pain in PwMS. The magnitude of the difference in pain scores between the intervention and control groups corresponds to a small to medium effect size, according to Cohen’s scale.69 Our results are consistent with previous reviews, systematic reviews, and meta-analyses reporting beneficial effects of exercise on disease outcomes in PwMS.15, 41, 42, 43 Our results are also consistent with

Conclusions

This is the first systematic review with meta-analysis that has investigated the effect of exercise interventions on pain in PwMS. Current pain management strategies are costly and have significant adverse effects, but exercise therapy has many benefits to health and is generally low-cost and accessible. Our meta-analysis of 10 trials shows that exercise may help alleviate pain in PwMS. However, the included studies were judged to be at high risk of bias, and our pooled estimate had high

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    C.M. is funded by an Early Career Fellowship from the National Health and Medical Research Council (ID: 1120014).

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