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Youth with chronic pain struggle to go to school, play sports, or spend time with friends and family due to pain. Medications are often ineffective, and aerobic exercise may improve both pain sensitivity and participation in valued life activities. This study will be the first to examine the impact of a single session of intense aerobic exercise on pain sensitivity measures in youth with and without chronic pain syndromes to help determine if aerobic exercise can improve pain and functioning.
Pediatric chronic pain syndromes that occur in 11-38% of youth commonly impact participation in school, family, and recreational activities. Pediatric chronic pain and disability can persist into adulthood if left untreated. Central sensitization is an overarching mechanism of pediatric and adult chronic pain syndromes and is conceptualized as an imbalance in the facilitatory and inhibitory pathways that control pain signal traffic in the central nervous system. Aerobic exercise commonly recommended to improve pain and disability, but empirical evidence is lacking. Exercise-induced hypoalgesia (EIH) is a proposed mechanism by which aerobic exercise improves pain sensitivity and is characterized by improved pain sensitivity immediately following exercise. To date, EIH has not been studied in youth with chronic pain syndromes. Insights may reveal potential treatment targets and mechanisms by which aerobic exercise can improve pain and quality of life among youth suffering from chronic pain. This study aims to 1) evaluate and compare EIH responses in youth with and without chronic pain and 2) identify potential biopsychosocial contributors to EIH. The investigators hypothesize that EIH is robust in pain-free youth, and present but attenuated in youth with chronic pain (Aim 1) and that unhelpful beliefs about pain will attenuate the effects of exercise on pain sensitivity (Aim 2). Results from this study will provide highly relevant data to design a clinical trial studying the effects of chronic aerobic exercise on pain and disability in these youth. Identification of effective nonpharmacologic treatments for chronic pain, such as exercise, may also reduce dependence on prescription medications and improve child health.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Youth with Chronic Pain Syndromes | Experimental | Youth with chronic pain will undergo quantitative sensory testing before and immediately after a single bout of intense aerobic exercise. |
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| Youth without Chronic Pain Syndromes | Active Comparator | Youth without chronic pain will undergo quantitative sensory testing before and immediately after a single bout of intense aerobic exercise. They will serve as a control group to determine if the intervention has different effects between groups. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Aerobic Exercise | Behavioral | Submaximal cardiovascular endurance testing on a treadmill |
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| Measure | Description | Time Frame |
|---|---|---|
| Pressure Pain Thresholds (PPT) | A pressure algometer is applied 3 times to 2 sites: the dominant quadriceps and deltoid using the Force Ten FDX pressure gauge (Wagner Instruments, Greenwich, CT). The pressure at which the participant reports pain is recorded and averaged over the three trials. Higher PPTs represent less pain sensitivity. | Before and after the intervention at baseline |
| Offset Analgesia Response | Percent decrease in pain reported between T2 and T3 interval of the offset analgesia test. Higher values represent greater pain inhibition. | Before and after the intervention at baseline |
| Temporal Summation of Heat Pain | To evaluate constant noxious heat pain summation, a noxious heat stimulus (60/100 on a visual analogue scale) is held for 60 seconds. Temporal summation is defined by an exponential increase in pain at the test end relative to the start; greater values represent greater pain facilitation. | Before and after the intervention at baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Fitkids Treadmill Test | Time to exhaustion (TTE) on the FTT provides an objective, norm-referenced marker of aerobic capacity in youth and is defined as the total time completed on the test, excluding the warm-up and cool-down phases. Data recorded includes TTE, rate of perceived exertion (Borg Scale), and maximum heart rate. Successful completion of the exercise session will be defined as achievement of > 85% age-predicted maximum heart rate. Greater TTE represents greater aerobic fitness. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Julie Shulman, PhD, DPT | Contact | 781-216-1650 | julie.shulman@childrens.harvard.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Boston Children's Hospital at 2 Brookline Place | Brookline | Massachusetts | 02445 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38743558 | Background | Chambers CT, Dol J, Tutelman PR, Langley CL, Parker JA, Cormier BT, Macfarlane GJ, Jones GT, Chapman D, Proudfoot N, Grant A, Marianayagam J. The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis. Pain. 2024 Oct 1;165(10):2215-2234. doi: 10.1097/j.pain.0000000000003267. Epub 2024 May 15. | |
| 32658151 |
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IPD not covered by the informed consent process will not be shared for privacy reasons.
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| ID | Term |
|---|---|
| D059350 | Chronic Pain |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D015444 | Exercise |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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Youth with chronic pain and healthy controls will complete all study outcomes in parallel.
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| Single measurement at baseline |
| Functional Disability Inventory | 15-item Likert scale of pain related disability. Higher scores represent greater disability. | Single measurement at baseline |
| Tampa Kinesiophobia Scale | Likert type scale of movement related fear. Higher scores indicate greater fear. | Single measurement at baseline |
| Pain Catastrophizing Scale | Likert type patient reported outcome of worry related to pain. HIgher score represent greater worries related to pain. | Single assessment at baseline |
| Fear of Pain Questionnaire Child | Patient reported outcome of pain related fear. Higher scores reflect greater fear. | Single assessment at baseline. |
| PROMIS Pediatric Pain Interference - Short Form 8a | Patient reported outcome of pain impact on life. Higher score reflect greater pain interference. | Single assessment at baseline |
| Central Sensitization Inventory | Patient reported outcome of the frequency of symptoms commonly experienced by persons with chronic pain. Higher score represent greater central sensitization. | Single assessment at baseline. |
| Numeric Pain Rating Scale | Self-reported pain intensity on an 11-point likert scale. Higher scores represent greater pain intensity. | Baseline - before and after intervention |
| Highly Sensitive Child Scale | Patient reported outcome of sensitivity to common daily sensory stimuli. Higher scores represent greater sensitivity. | Single measurement at baseline |
| Shulman J, Zurakowski D, Keysor J, Jervis K, Sethna NF. Offset analgesia identifies impaired endogenous pain modulation in pediatric chronic pain disorders. Pain. 2020 Dec;161(12):2852-2859. doi: 10.1097/j.pain.0000000000001984. |
| 30904519 | Background | Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, Graven-Nielsen T, Polli A. Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. J Pain. 2019 Nov;20(11):1249-1266. doi: 10.1016/j.jpain.2019.03.005. Epub 2019 Mar 21. |
| 11929939 | Background | Grill JD, Coghill RC. Transient analgesia evoked by noxious stimulus offset. J Neurophysiol. 2002 Apr;87(4):2205-8. doi: 10.1152/jn.00730.2001. |
| 25856681 | Background | Stolzman S, Danduran M, Hunter SK, Bement MH. Pain Response after Maximal Aerobic Exercise in Adolescents across Weight Status. Med Sci Sports Exerc. 2015 Nov;47(11):2431-40. doi: 10.1249/MSS.0000000000000678. |
| 27661245 | Background | Stolzman S, Bement MH. Does Exercise Decrease Pain via Conditioned Pain Modulation in Adolescents? Pediatr Phys Ther. 2016 winter;28(4):470-3. doi: 10.1097/PEP.0000000000000312. |