> Different therapists have said different things [contradictory advice on pain with exercise]…and it makes you wonder which therapist to believe. Exercise is a proven treatment for managing at least some persistent pain, including musculoskeletal-related pain.1 2 But an area often overlooked is what type of pain and what intensity of pain should be associated with exercise. What would achieve the best results? No pain? A little pain? A moderate amount of pain? How does the patient judge what is ‘a little’ or ‘moderate’? How much pain is too much? Is there ‘good pain’ as patients often tell us when stretching or massaging a muscle, as well as ‘bad pain’ (presumably thought to be harmful)? Qualitative research tells us that many individuals with persistent pain are uncertain when it comes to pain and exercise.3 4 This is closely linked to pain-related fear and questions as to whether exercise is helpful or harmful. As one patient framed it, ‘Are you making it worse? And that’s the crux of it really…if this is hurting should I really be doing this?’.3 There are few …

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房间里的大象：痛到什么程度才行？如果理疗运动 RCT 不报告，我们永远不会回答这个问题

> 不同的治疗师说了不同的话[关于运动疼痛的矛盾建议]……这让你怀疑该相信哪个治疗师。运动是一种行之有效的治疗方法，至少可以控制一些持续性疼痛，包括肌肉骨骼相关的疼痛。1 2 但一个经常被忽视的领域是运动应该与哪种类型的疼痛和疼痛强度相关联。什么会取得最好的结果？不痛？有点痛？适度的疼痛？患者如何判断什么是“有点”或“中等”？多少痛苦是太多？是否有患者在拉伸或按摩肌肉时经常告诉我们的“好痛”和“坏痛”（可能被认为是有害的）？定性研究告诉我们，许多持续疼痛的人在疼痛和运动方面都不确定。3 4 这与疼痛相关的恐惧以及运动有益还是有害的问题密切相关。正如一位患者所描述的那样，‘你让情况变得更糟了吗？这真的是问题的关键......如果这很痛苦，我真的应该这样做吗？'.3 很少有......