Pain neuroscience education (PNE) has shown promising results in the management of patients with chronic spinal pain (CSP). However, no previous review has determined the optimal dose of PNE added to an exercise programme to achieve clinically relevant improvements. The aim was to determine the dose–response association between PNE added to an exercise programme and improvements in pain intensity and disability in patients with CSP. A systematic search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Library was conducted from inception to April 19, 2023. The exposure variable (dosage) was the total minutes of PNE. Outcome measures included pain intensity, disability, quality of life, pressure pain thresholds, and central sensitization inventory. Data extraction, risk-of-bias assessment, and certainty of evidence were performed by 2 independent reviewers. The dose–response relationship was assessed using a restricted cubic spline model. Twenty-six randomised controlled trials with 1852 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain intensity and disability. In addition, a dose of 200 and 150 minutes of PNE added to an exercise programme was estimated to exceed the minimum clinically important difference described in the literature for pain intensity (−2.61 points, 95% CI = −3.12 to −2.10) and disability (−6.84 points, 95% CI = −7.98 to −5.70), respectively. The pooled effect of the isolated exercise was small. These findings may be useful in optimising the most appropriate PNE dose to achieve clinically relevant improvements in patients with CSP.

Objective: This narrative review aims to analyze physical activity as a central pillar of lifestyle modification in the management of chronic musculoskeletal pain by examining its effects on pain modulation as well as related lifestyle domains, including sleep, stress regulation, dietary habits, and smoking behavior. Methods: A narrative structured review was conducted. We searched MEDLINE/PubMed, Embase, and Cochrane Reviews using terms related to chronic pain and lifestyle. Randomized controlled trials, observational studies, systematic reviews, and narrative reviews reporting on the concepts of interest were included. The results were synthesized and described narratively. Results: Through the release of neuromodulatory compounds such as endorphins, endocannabinoids, dopamine, and serotonin, exercise improves analgesia, promotes emotional resilience, and reduces the reward response associated with addictive behaviors such as smoking. Its effects on the hypothalamic–pituitary–adrenal axis reduce cortisol levels, while melatonin regulation promotes circadian synchronization and deeper sleep stages. In addition, exercise modulates appetite by increasing insulin sensitivity and altering hormones such as leptin and ghrelin, contributing to appetite control and energy balance. These mechanisms support a comprehensive approach to chronic pain management. Conclusions: Physical activity is a core component of lifestyle-based chronic pain management, not only because of its analgesic effects, but also because of its positive influence on sleep, stress regulation, dietary habits, and smoking reduction. Although the available evidence is promising, more randomized controlled trials are needed to examine the effects of exercise on other healthy lifestyle behaviors, such as stress reduction, dietary modification, and smoking cessation, to consolidate its role in the comprehensive prevention and management of chronic pain.

Objective: The purpose of this study was to examine the dose-response relationship between aerobic exercise programs and changes in pain intensity and health status in patients with fibromyalgia. Data Sources: Data sources for this study were PubMed, PEDro, Google Scholar, and EBSCO from inception until February 9, 2024. Study Selection: Randomized controlled trials (RCTs) of aerobic exercise in patients with a clinical diagnosis of fibromyalgia were included. Data Extraction: Outcome measures were pain intensity (Visual Analog Scale) and health status (Fibromyalgia Impact Questionnaire (FIQ)). The dose-response relationship was evaluated using a restricted cubic spline model. Data Synthesis: Twenty-three RCTs were included. The meta-analysis showed a significant improvement in pain intensity and functional status. A minimum dose of 50 min per week standardized mean difference (SMD = −0.67; 95% CI = −0.70 to −0.65) and a total duration of 600 min (SMD = −0.65; 95% CI = −0.69 to −0.62) were estimated to effectively reduce pain intensity. The maximum effect was achieved with 90 min per week (SMD = −1.14; 95% CI = −1.19 to −1.09) and 1200 min total duration (SMD = −1.08; 95%CI = −1.13 to −1.02). Additionally, a minimum dose of 65 min per week (SMD = −0.62; 95% CI = −0.6 to −0.69) and a total duration of 950 min (SMD = −0.61; 95% CI = −0.60 to −0.67) were estimated to effectively reduce the FIQ score. While the maximum effect was obtained with 150 min per week (SMD = −1.77; 95% CI = −1.89 to −1.65) and 3000 min of total duration (SMD = −1.43; 95% CI = −1.54 to −1.31). Conclusion: These findings may be useful in optimizing the minimal dose of aerobic exercise to achieve health improvements in people with fibromyalgia.

Chronic pain is a global problem, with a prevalence of 35–50%. This multifactorial condition is influenced by biological, psychological, and social factors.We assessed the efficacy of pain neurosci...