Offset analgesia can be translated into exercise prescription to reduce pain and improve feelings during isometric exercise in young healthy adults.
Key Findings
Results
Offset analgesia (OffA) was successfully demonstrated during an isometric exercise task, with pain dropping significantly after returning to the original exercise intensity.
49 young healthy adults participated (24 women, mean age 21.8 ± 2.0 years; 25 men, mean age 23.4 ± 5.7 years)
Exercise OffA protocol involved isometric knee extension at 25% MVC until moderate pain (T1), increased to 50% MVC for 10 seconds (T2), then returned to 25% MVC for 10 seconds (T3)
Pain increased during T2 (intensity increase phase) and dropped significantly during T3 (return to original intensity)
The pain reduction was described as 'clinically meaningful' regardless of noxious stimulus type
Results
Thermal offset analgesia was also confirmed using noxious heat stimuli applied to the forearm.
Thermal OffA protocol applied noxious heat at an individualized test temperature causing moderate pain (T1), increased by 1°C for 10 seconds (T2), then returned to the test temperature for 10 seconds (T3)
Pain increased when temperature increased (T2) and dropped significantly following the return to baseline temperature (T3)
A control task was conducted whereby noxious stimulus intensity remained constant for comparison
Both thermal and exercise protocols used individualized test temperatures or exercise intensities to achieve moderate pain
Results
Affective valence at the end of exercise was significantly more positive during the offset task than the control task.
Affective valence (feelings towards exercise) was more positive during the offset exercise task compared to the control task (p<0.001)
Affective valence was measured during exercise only, not during the thermal task
Each participant completed two research sessions in randomized order, one control and one offset exercise task
The improvement in affective valence suggests OffA may improve subjective experience of exercise beyond just pain reduction
Methods
The study design used a within-subjects crossover approach with individualized stimulus intensities to elicit moderate pain.
Participants completed two research sessions, with one randomized exercise task (control or offset) in each session
Exercise intensity was set at 25% of maximal voluntary contraction (MVC) as the baseline, increased to 50% MVC during the T2 phase
Pain was reported during T1, T2, and T3 for all thermal and exercise protocols
Individualized test temperatures and exercise intensities were used to ensure moderate pain was achieved for each participant
Conclusions
The authors conclude that offset analgesia can be applied to exercise prescription as a strategy to reduce pain and improve feelings during isometric exercise.
OffA produced clinically meaningful pain reduction with both heat and exercise stimuli
The translation of OffA to an exercise context was the primary objective of the study
Findings suggest potential application of OffA principles in designing exercise protocols for individuals experiencing exercise-related pain
The study was conducted in young healthy adults, representing a specific population with potential limitations in generalizability
What This Means
This research suggests that a pain-relief phenomenon called 'offset analgesia' — where a brief increase in pain stimulus followed by a return to the original level causes pain to drop below what it was before the increase — can be applied not just to heat pain but also to exercise-induced muscle pain. In the study, participants held an isometric (stationary) leg contraction at a moderate intensity until it became moderately painful, then briefly increased the effort to a higher level, and finally returned to the original moderate intensity. When they returned to the original effort level, they reported significantly less pain than they had before the increase, mirroring what happens with heat-based offset analgesia. This clinically meaningful pain reduction occurred reliably across participants.
Beyond just reducing pain, the study also found that participants reported more positive feelings about the exercise experience during the offset protocol compared to a control condition where intensity stayed constant. This suggests that strategically varying exercise intensity — even briefly increasing it — might make the overall experience feel better emotionally, not just hurt less. The study was conducted in young, healthy adults performing a controlled laboratory task, so further research would be needed to determine whether this approach works for older adults, people with chronic pain, or in real-world exercise settings. Nonetheless, these findings open the door to incorporating offset analgesia principles into how exercise sessions are structured to help make physical activity feel less painful and more tolerable.
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Gutsch S, McChesney R, Brinkmann T, Bement M. (2026). Reducing pain during exercise with offset analgesia in young healthy adults.. Scandinavian journal of pain. https://doi.org/10.1515/sjpain-2026-0022