Pre-exercise conditioned pain modulation (CPM) efficiency was associated with exercise-induced hypoalgesia magnitude in patients with painful rotator cuff tears, with a CPM cutoff of 4.05 kPa identifying responders to exercise-induced pain reduction.
Key Findings
Results
Moderate-intensity stationary cycling produced a clinically meaningful reduction in movement-evoked pain in patients with painful rotator cuff tears.
30 patients with symptomatic rotator cuff tear performed 25 minutes of moderate-intensity stationary cycling
Median reduction in movement-evoked pain during active shoulder flexion was 21.0 mm (IQR: 9.0–35.0 mm)
The reduction was statistically significant (p < 0.001) with a large effect size (r = 0.83)
Movement-evoked pain was assessed using a visual analogue scale or similar scale before and immediately after exercise
Results
Pressure pain thresholds (PPTs) increased at all three measurement sites following exercise, indicating widespread hypoalgesia.
PPT increases were observed at the affected deltoid, contralateral deltoid, and contralateral tibialis anterior
All three sites showed statistically significant increases (p < 0.05)
The widespread nature of PPT increases at remote sites (contralateral limb) suggests a systemic, centrally mediated mechanism
PPTs were assessed using cuff algometry or pressure algometry before and immediately after the exercise bout
Results
Pre-exercise CPM efficiency was moderately correlated with the magnitude of post-exercise pain reduction.
Spearman correlation coefficient between CPM efficiency and post-exercise pain reduction was ρ = 0.56 (p = 0.002)
CPM was evaluated using cuff algometry before the intervention
This indicates that individuals with greater endogenous pain inhibitory capacity experienced greater exercise-induced hypoalgesia
The correlation was described as 'moderate' by the authors
Results
ROC analysis identified a CPM cutoff value of 4.05 kPa that distinguished EIH responders from non-responders with high accuracy.
The area under the curve (AUC) was 0.917, indicating excellent discriminative ability
The CPM cutoff value was 4.05 kPa
This suggests that pre-exercise CPM could serve as a clinical marker for predicting individual analgesic response to exercise
The ROC analysis was performed to detect 'EIH responders' based on post-exercise movement-evoked pain reduction
Discussion
Pre-exercise CPM was identified as a potential marker of inter-individual variability in the immediate analgesic response to exercise in a clinical musculoskeletal pain population.
The study population consisted of 30 patients with symptomatic rotator cuff tear
Unlike previous studies focusing primarily on experimental pain sensitivity, this study demonstrated clinically meaningful reductions in movement-evoked pain
Authors suggest these findings 'provide a basis for future mechanism-based stratification of exercise interventions'
Greater pre-exercise endogenous pain inhibitory function was associated with greater post-exercise pain reduction
What This Means
This research suggests that a single session of moderate-intensity cycling (25 minutes) can meaningfully reduce shoulder pain during arm movement in patients with rotator cuff tears — a common and often debilitating shoulder condition. Pain scores dropped by a median of 21 mm after exercise, and sensitivity to pressure also decreased not just in the injured shoulder but also in distant body regions, suggesting the pain relief is driven by the brain's own pain-suppression systems rather than just local effects at the shoulder.
The study also found that patients who already had a stronger natural pain-suppression system before exercising — measured using a test called conditioned pain modulation (CPM), which involves comparing pain responses under different conditions — experienced greater pain relief from exercise. A specific CPM threshold value of 4.05 kPa was identified that could distinguish patients who are likely to respond well to exercise from those who are not, with high accuracy (AUC of 0.917).
This research suggests that measuring a patient's pain-suppression capacity before starting an exercise program could help predict how much pain relief they will get from exercise. This could eventually allow clinicians to tailor exercise-based treatments — for example, prioritizing exercise therapy for patients whose nervous systems are well-equipped to generate pain relief, while considering alternative approaches for those with impaired pain inhibition. The findings open the door to more individualized, mechanism-based physical therapy for shoulder pain.
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Oda S, Izumi M, Horino T, Hayashi Y, Ooishi D, Morimoto T, et al.. (2026). Pre-Exercise Conditioned Pain Modulation Is Associated With Exercise-Induced Hypoalgesia in Patients With Painful Rotator Cuff Tears.. European journal of pain (London, England). https://doi.org/10.1002/ejp.70426