PSYCHIATRIC MANAGEMENT OF PAIN (MR CLARK, SECTION EDITOR) The Role of Exercise and Types of Exercise in the Rehabilitation of Chronic Pain: Specific or Nonspecific Benefits Amy Burleson Sullivan & Judith Scheman & Deborah Venesy & Sara Davin Published online: 19 January 2012 # Springer Science+Business Media, LLC 2012 Abstract Chronic pain is one of the most common com- plaints seen in general practitioners’ offices, and it contrib- utes to social, emotional, physical, and economical losses. The management of this problem poses challenges for health care providers when the current treatment of choice for chronic pain is pharmacological management, which may not be a sufficient and/or holistic approach to the management of chronic pain. Our goal is to increase aware- ness of the significance of physical activity, as well as examine additional cost-effective, integrated approaches to help manage the complex and debilitating effects of this condition. This article summarizes the types of exercise in the rehabilitation of chronic pain patients and provides practical recommendations for the clinician based on empir- ical and clinical experience. This safe, cost-free, nonphar- macologic way of managing pain has been found to reduce anxiety and depression, improve physical capacity, increase functioning and independence, and reduce morbidity and mortality. Keywords Adjunctive therapy . Aerobic exercise . Stretching . Flexibility . Anaerobic exercise . Interdisciplinary pain programs . Yoga . Pilates . Tai Chi . Pain management . Chronic pain . Rehabilitation Introduction An estimated 86 million Americans are affected by some form of chronic pain, more individuals than diabetes, heart disease, and cancer combined [1, 2], making pain the pri- mary complaint of approximately 40% of patients seeking help from general practitioners. The costs associated with treatment of chronic pain are staggering, with over $100 billion in treatment-related costs and lost work productivity [3–5]. In addition to the financial strain, chronic pain can contribute to decreases in quality of life through physical, relational, social, and psychological losses. Frequently, pharmacologic management is the treatment of choice in managing chronic pain; however, it may not treat both the physical and psychological losses of chronic pain. A grow- ing body of literature has demonstrated that opioids may fail to provide pain relief and can lead to decreased functioning in many chronic pain patients. Nonetheless, opioids contin- ue to be amongst the most commonly prescribed medica- tions, accounting for over 235 million prescriptions [6, 7]. With this information, it is important to increase awareness of the significance of physical activity as well as to examine additional, integrated approaches to help manage the com- plex and debilitating effects of this increasingly difficult condition [5, 8]. Although there are few known effective treatment options for patients with chronic pain, integrating comple- mentary therapies into a conventional medical treatment plan can help manage chronic pain and reduce reliance on A. B. Sullivan Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Mail Code U10, 9500 Euclid Avenue, Cleveland, OH 44195, USA J. Scheman (*) : S. Davin Neurological Center for Pain, Cleveland Clinic, Mail Code C21, 9500 Euclid Avenue, Cleveland, OH 44195, USA e-mail: schemaj@ccf.org D. Venesy Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA Curr Pain Headache Rep (2012) 16:153–161 DOI 10.1007/s11916-012-0245-3