Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study.

Observed Findings

• Pain pressure thresholds decreased following submaximal exercise in chronic WAD patients, while they increased in healthy controls.
• ChronicWAD patients reported worsening of their symptom complex following both exercise bouts.
• Self-paced, physiologically limited exercise triggered fewer post-exercise symptoms compared to submaximal standardized exercise in WAD patients.
• Pain pressure thresholds at the calf were the exception, increasing slightly even after self-paced exercise in WAD patients.
• Healthy controls showed opposite responses to WAD patients, with increased pain thresholds (improved pain tolerance) after both exercise types.

Inferred Conclusions

• Chronic WAD patients have impaired endogenous pain inhibition during exercise, demonstrating abnormal central pain processing.
• Submaximal exercise triggers post-exertional malaise in chronic WAD, while self-paced exercise produces less severe symptom exacerbation.
• Individualized, targeted exercise therapies tailored to individual physiological limits are preferable to standardized exercise prescriptions for chronic WAD patients.
• Caution should be exercised when recommending standard exercise programs to people with chronic WAD due to risk of symptom exacerbation.

Remaining Questions