The effectiveness of exercise interventions for pain reduction in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Thibaut Demaneuf MSc, Zoe Aitken MSc, et al


To systematically review the evidence of the effect of exercise compared to passive control on pain in people with multiple sclerosis.

Data source and study selection
Five electronic databases were searched for randomized controlled trials published up to March 2017 that recruited people with multiple sclerosis where exercise was the intervention and pain was an outcome. (PROSPERO registration number CRD42017060489).

Statistical analysis
A random-effects meta-analysis was conducted to estimate the standardized mean difference of the effect of exercise on pain between treatment and control groups. We assessed risk of bias, fitted meta-regression models to explore heterogeneity between studies, and assessed small study effects.

Data synthesis
Ten studies met the inclusion criteria (total sample size = 389) and all studies were at high risk of bias. We found that exercise intervention was associated with less pain compared to passive control groups (standardized mean difference = -0.46; 95% CI: -0.92, 0.00). There was high between study heterogeneity (I2 = 77.0%), which was not explained by the pre-specified study characteristics. There was also some evidence of small study effects.

This is the first systematic review of the effect of exercise interventions on pain in people with multiple sclerosis, a chronic neurological disorder that affects 2.5 million people. We found some evidence that exercise compared to passive control alleviates pain in this population, but there were limitations in reporting and study quality with high risk of bias of individual studies and heterogeneity between studies.