Author Login

Correspondence to Author: Gen Lia†, Xuewan Lina†, Zheng Wangb, Songtao Wanga* . 

a. School of Physical Education & Sports Science, South China Normal University, Guangzhou, 510006, China.
b. Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
†. These authors have contributed equally to this work.

DOI: 10.52338/jop.2026.5336

Abstract:

Background: Chronic pain affects over 20% of adults worldwide, and traditional pharmacological treatments have limitations in efficacy and safety concerns. Exercise-induced hypoalgesia (EIH), as a non-pharmacological analgesic mechanism, demonstrates broad application prospects in chronic pain management. This review aims to systematically summarize the neurobiological mechanisms, clinical evidence, and practical application strategies of EIH.
Methods: This review synthesizes current evidence on EIH mechanisms across central, peripheral, and psychosocial domains, and examines clinical findings in patients with chronic pain conditions, including low back pain, osteoarthritis, chronic neck pain, and fibromyalgia.
Results:EIH involves coordinated activation of descending pain inhibitory pathways, release of endogenous opioids and monoaminergic neurotransmitters, peripheral immune modulation through myokine secretion, and psychosocial factors including expectancy, pain catastrophizing, and kinesiophobia. In chronic pain patients, structured exercise interventions demonstrate analgesic effects, though responses exhibit significant disease-specificity and individual variability. Notably, patients with central sensitization syndromes may exhibit attenuated or paradoxical hyperalgesic responses to exercise.
Conclusion: EIH is a multidimensional phenomenon integrating physiological and psychological mechanisms. Clinical application requires individualized exercise prescription encompassing modality, intensity, duration, and frequency, combined with multimodal integration and patient stratification based on pain phenotype and endogenous pain modulation capacity. Future research should prioritize development of predictive biomarkers for EIH, longitudinal outcome studies, and mechanistic investigations in refractory pain populations to advance precision exercisebased pain management.
Perspective: This review synthesizes neurophysiological and psychological mechanisms underlying exercise-induced hypoalgesia and its clinical applications in chronic pain management. Understanding how exercise modulates pain through central and peripheral pathways can guide clinicians in designing personalized, evidence-based exercise interventions to optimize analgesic outcomes while minimizing risks of exercise-induced hyperalgesia in vulnerable populations.

Keywords: Exercise-induced hypoalgesia; Chronic pain; Pain modulation; Descending pain modulation; Exercise prescription

Citation:

Dr.Gen Li, Exercise-Induced Hypoalgesia: Mechanisms, Clinical Evidence, And Implications For Chronic Pain Management. Journal of Pain 2026.