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NICE guidelines for management of chronic pain published 7th April 2021

Non-pharmacological management of chronic primary pain

Exercise programmes and physical activity for chronic primary pain

1.2.1Offer a supervised group exercise programme to people aged 16 years and over to manage chronic primary pain. Take people's specific needs, preferences and abilities into account.

1.2.2Encourage people with chronic primary pain to remain physically active for longer-term general health benefits (also see NICE guidelines on physical activity and behaviour change: individual approaches).

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on exercise programmes and physical activity for chronic primary pain .

Full details of the evidence and the committee's discussion are in evidence review E: exercise for chronic primary pain.


Exercise programmes and physical activity for chronic primary pain

Recommendations 1.2.1 and 1.2.2

Why the committee made the recommendations

Evidence from many studies showed that exercise reduced pain (23 studies) and improved quality of life (22 studies) compared with usual care in people with chronic primary pain. Benefit was seen for both short‑ and long‑term follow up and was consistent across different types of exercise. Most of the evidence was for professionally led supervised group exercise and for women with fibromyalgia or people with chronic neck pain. As there was no evidence to suggest that effectiveness differed for types of chronic primary pain, it was agreed there was no reason this evidence could not apply for the whole review population. There was limited evidence comparing different types of exercise with each other although, from what was available, there was minimal difference between the types. The committee agreed the most appropriate type of exercise may depend on the type of pain. For these reasons, the committee did not specify what type of exercise should be used, and agreed it could be any of the types included in the studies reviewed (cardiovascular, mind–body, strength, or a combination of approaches).

An economic model comparing exercise (all types) with no exercise was developed for this guideline and showed that exercise was likely to be cost effective (both if using only the time horizon of the trials and also when extrapolating the quality of life gain beyond the trials). The analysis used studies in which exercise was predominantly group based. The committee considered the results to be robust, and agreed that the studies used in the model were representative of the whole evidence review. Exercise remained cost effective when the assumed benefits and costs were varied (sensitivity analysis).

There were no negative effects demonstrated except for more people discontinuing from exercise programmes. The committee agreed that people are more likely to continue with exercise if the programme offered suits their lifestyle and physical ability and addresses their individual health needs. They agreed that the choice of programme as well as the content should take into account people's abilities and preferences. This might include providing individual exercise advice for different members of a group.

The committee's experience was that many people with chronic primary pain find it difficult to be physically active. The committee agreed that it is important for these people to continue to be physically active after a formal exercise programme ends, but the type of physical activity should be sustainable for the person.

How the recommendations might affect practice

The types of exercise programmes currently offered vary from place to place, often determined by the needs of the local population. In areas where supervised group exercise is currently not provided, implementing the recommendation will lead to increased resource use.

The committee discussed that if costs are incurred by engaging in physical activity after a formal exercise programme ends, this would be a personal cost for people with chronic primary pain, and would not fall to the NHS.

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