Effects of Four Weeks of Functional Rehabilitation on Exercise-induced Hypoalgesia in Individuals With Chronic Low Back Pain: An Exploratory Study

Chronic low back pain is a common condition characterized by persistent and disabling pain located in the lower back, leading to physical and psychosocial limitations in daily life activities. Physical exercise is currently considered the primary therapeutic approach to promote positive outcomes in individuals with chronic low back pain. However, pain itself remains a major barrier to regular and sustained engagement in physical activity in this population.

In healthy individuals, physical exercise induces an analgesic effect known as exercise-induced hypoalgesia, which is reflected by increased pain detection thresholds following exercise. Enhancing exercise-induced hypoalgesia may help improve adherence to regular physical activity among individuals with chronic low back pain. Nevertheless, the mechanisms underlying this phenomenon remain insufficiently understood. Previous research suggests that regular physical activity may facilitate exercise-induced hypoalgesia through physiological responses to exercise that can be modulated by physical activity levels.

Therefore, physical activity-centered rehabilitation programs may enhance exercise-induced hypoalgesia in individuals with chronic low back pain, potentially contributing to pain reduction, increased physical activity participation, and decreased healthcare utilization.

This exploratory, prospective, single-center interventional study aims primarily to evaluate the effects of a four-week functional rehabilitation program, with physical activity as its main component, on exercise-induced hypoalgesia in individuals with chronic low back pain. Exercise-induced hypoalgesia will be assessed by measuring pain detection thresholds before and after a standardized exercise bout using pressure algometry.

Secondary objectives are twofold. First, the study will examine the relationships between exercise-induced hypoalgesia and individual characteristics associated with chronic low back pain, including pain intensity, functional disability, kinesiophobia, hemodynamic responses to exercise, and physical activity level. Second, the study will determine whether changes in exercise-induced hypoalgesia at the end of the rehabilitation program predict the subsequent evolution of pain symptoms, healthcare utilization, and the resumption of daily physical and occupational activities at 3 months, 6 months, and 1 year following the intervention.