Physical activity should be the primary intervention for individuals living with pain

Key points

1. 01Physical activity (PA) is supported by high-quantity evidence as an intervention for chronic pain, covering nociceptive, nociplastic, and neuropathic conditions.
2. 02All health professionals, not just exercise specialists, should assess PA levels, advise on safety, and deliver brief PA interventions.
3. 03Even low-to-moderate intensity PA, such as a 30-minute brisk walk on most days, produces meaningful health benefits for people with chronic pain.
4. 04Discussing expected post-exercise soreness (peaking day 2-3) and agreeing on acceptable pain levels is essential to support adherence.
5. 05Ongoing support including goal review, barrier identification, and follow-up is needed to sustain PA long-term.

How it was conducted

Design

Expert consensus position paper using iterative development by the EFIC 'On The Move' Task Force

Process

Recommendations drafted from international best practice guidelines (WHO, ISPAH, ACSM, CDC, Exercise is Medicine) and refined through input from Pain Forum Members and Pain Alliance Europe

Endorsement

Formally endorsed by European Pain Forum members, EFIC Executive Board, and Pain Alliance Europe

Target population

Adults living with any chronic pain condition with a long life expectancy

Scope

Guidance for all health professionals, not limited to exercise or pain specialists

What they found

• Five recommendations produced: (1) take a PA history and put PA on the agenda, (2) advise that PA is important and safe, (3) deliver a brief PA intervention, (4) discuss acceptable levels of PA-related soreness and pain, (5) provide ongoing support in staying physically active.
• Evidence cited supports PA efficacy for pain relief in the short and long term across nociceptive, nociplastic, and neuropathic pain conditions (Ferro Moura Franco et al., 2021; Geneen et al., 2017; Roos et al., 2021; Zhang et al., 2021).
• Even low-to-moderate intensity PA can lead to improvements in pain, daily function, and quality of life (Loew et al., 2012; Mansi et al., 2014; O'Connor et al., 2015).
• Brief PA interventions in primary care are cited as cost-effective and producing relevant increases in PA (Hall et al., 2022).
• Behaviour change techniques (goal setting, self-monitoring, feedback, behaviour review) are associated with increased intervention effects (Michie et al., 2009).
• Delayed onset muscle soreness after PA typically peaks on day 2 or 3 and is described as a normal biological response.

Limitations

• This is a consensus position paper, not a systematic review or primary study; it does not generate new empirical evidence.
• Recommendations are generic and may not account for the heterogeneity of specific chronic pain conditions or individual patient complexity.
• Barriers such as inadequate clinician knowledge, time constraints, and reimbursement issues are acknowledged but not empirically addressed by the paper itself.
• The paper acknowledges that simply telling patients their fear-avoidance beliefs are wrong is often insufficient to change those beliefs.

Why it matters

For patients

People with chronic pain can safely start or increase physical activity at low intensity and expect gradual improvements in pain and quality of life, even without a specialist referral.

For clinicians

All health professionals should routinely screen for PA levels, briefly counsel patients on its safety and benefits, and provide ongoing support regardless of clinical specialty.

For readers

This EFIC position paper consolidates existing evidence into five actionable recommendations, providing a practical framework for integrating PA promotion into chronic pain care at every contact.