Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta-analysis.

This systematic review with meta-analysis asked whether different exercise prescriptions matter for chronic pain conditions thought to involve nociplastic pain, meaning pain driven by altered nervous system processing rather than clear tissue damage. It included 50 randomized controlled trials with 3,562 participants covering fibromyalgia, chronic whiplash-associated disorders, and chronic idiopathic neck pain, comparing exercise parameters like type, dose, and duration. For fibromyalgia, aerobic and strengthening exercise performed similarly to each other and better than stretching alone, typically delivered in 50 to 60 minute supervised sessions two to three times weekly for 13 weeks or more. For whiplash disorders, body awareness exercise was similar to combined exercise, and adding sling exercise to strengthening made no difference.

For neck pain, motor control and general strengthening exercise had similar effects. The authors suggest pain mechanism should guide prescription, favoring longer, lower-intensity global exercise for nociplastic-type pain, though the review does not detail risk of bias or heterogeneity across the pooled trials.

If you live with fibromyalgia, whiplash-related pain, or persistent neck pain, you may wonder which type of exercise works best. This review combined 50 clinical trials involving 3,562 people to compare different exercise approaches, such as aerobic versus strengthening versus stretching, and different session lengths and durations. For fibromyalgia, aerobic and strengthening exercise worked about the same as each other and better than stretching alone, usually done in 50 to 60 minute supervised sessions, two to three times a week, for 13 weeks or longer.

For whiplash-related pain, body awareness exercise and combined exercise programs had similar results, and adding sling-based exercise to strengthening did not change outcomes. For neck pain, motor control exercise and general strengthening had similar effects. The researchers suggest that pain type may matter when choosing exercise, with longer, gentler, whole-body exercise potentially suiting conditions like fibromyalgia and whiplash.

The review does not report how reliable the individual trials were, so these patterns should be seen as a summary of existing evidence rather than a settled answer.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review with meta-analysis pooled 50 randomized controlled trials (n=3,562) comparing exercise parameters across three conditions positioned along a nociplastic pain continuum: fibromyalgia, chronic whiplash-associated disorders, and chronic idiopathic neck pain. Comparisons addressed exercise mode, dosage, session length, and program duration rather than exercise versus no exercise. Findings indicate aerobic and strengthening exercise produced similar effects in fibromyalgia and both outperformed stretching alone, with typical protocols of 50 to 60 minute supervised sessions, two to three times weekly, over 13 or more weeks.

In whiplash disorders, body awareness and combined exercise were comparable, and adding sling exercise to strengthening conferred no additional benefit. In neck pain, motor control and nonspecific strengthening exercise showed similar effects, generally over shorter 7 to 12 week programs. The authors propose that global, longer-duration, lower-intensity exercise may suit nociplastic-predominant presentations while more specific, intensive, shorter programs may suit nociceptive-predominant conditions like neck pain.

The abstract does not specify pooled effect sizes, heterogeneity statistics, or risk-of-bias ratings for included trials, so the certainty of these comparative equivalence findings and their generalizability remain uncertain.