A new form of exercise therapy named as painful exercises focused on loading and resistance programmes for temporary pain relief in patients with chronic musculoskeletal pain has found to offer significant benefit. In a systematic review and meta-analysis, the painful exercises were compared with non-painful exercises. For this review, two authors independently selected studies and appraised risk of bias. Methodological quality was determined by using the Cochrane risk of bias tool. The quality of evidence was assessed through the Grading of Recommendations Assessment system.

The literature search identified 9081 potentially eligible studies. Inclusion criteria were met by nine papers (from seven trials) with 385 participants. There was the significant short-term difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. No significant difference was seen for pain in the medium and long-term, and function and disability in the short, medium and long-term.

Findings of the study revealed that protocols which were under painful exercises showed a small but significant benefit over pain-free exercise in the short term, with the moderate quality of evidence. But in medium and long-term the superiority of one treatment over another was not clear. 

Further research is necessary to completely evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders.