Endogenous Modulation of Pain: The Role of Exercise, Stress, and Cognitions in Humans

Henrik B Vaegter, Elisabeth Fehrmann, Hannah Gajsar, Nina Kreddig

Research output: Journal article (peer-reviewed)Review article

18 Citations (Scopus)


BACKGROUND: Pain is a complex and highly subjective phenomenon that can be modulated by several factors. On the basis of results from experimental and clinical studies, the existence of endogenous pain modulatory mechanisms that can increase or diminish the experience of pain is now accepted.

METHODS: In this narrative review, the pain modulatory effects of exercise, stress, and cognitions in humans are assessed.

RESULTS: Experimental studies on the effect of exercise have revealed that pain-free participants show a hypoalgesic response after exercise. However, in some patients with chronic pain, this response is reduced or even hyperalgesic in nature. These findings will be discussed from a mechanistic point of view. Stress is another modulator of the pain experience. Although acute stress may induce hypoalgesia, ongoing clinical stress has detrimental effects on pain in many patients with chronic pain conditions, which have implications for the understanding, assessment, and treatment of stress in patients with pain. Finally, cognitive strategies play differing roles in pain inhibition. Two intuitive strategies, thought suppression and focused distraction, will be reviewed as regards experimental, acute, and chronic pain.

CONCLUSION: On the basis of current knowledge on the role of exercise, stress, and cognitive pain control strategies on the modulation of pain, implications for treatment will be discussed.

Original languageEnglish
Pages (from-to)150-161
Number of pages12
JournalClinical Journal of Pain
Issue number3
Publication statusPublished - 01 Mar 2020


  • Chronic Pain
  • Cognition
  • Exercise
  • Humans
  • Pain Management
  • Pain Measurement
  • Stress, Psychological
  • stress
  • cognition
  • pain sensitivity
  • thought suppression
  • exercise-induced hypoalgesia
  • endogenous pain modulation
  • focused distraction

ASJC Scopus subject areas

  • Neurology (clinical)
  • Anesthesiology and Pain Medicine


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