Effect of a structured stretching exercise program on resolution of myofascial pain and opioid usage in "legacy pain" patients: A retrospective cohort study

Pain Pract. 2022 Apr;22(4):447-452. doi: 10.1111/papr.13100. Epub 2022 Feb 4.


Objective: The aim of this study was to determine whether the implementation of a structured exercise stretching routine targeted at resolving myofascial pain is effective in improving outcomes of "legacy pain" patients.

Design: Retrospective cohort study.

Setting: Private community-based interventional pain management practice.

Subjects: "Legacy pain" patients, defined as patients on opioid therapy for >1 year.

Methods: Subjects were initiated on a structured home exercise stretching routine targeted at resolving myofascial pain consisting of 14 lumbar, four thoracic, and seven cervical stretches as appropriate. Daily morphine milligram equivalent, functional status (Oswestry Disability Index), and pain level (Numeric Rating Scale) were compared pre- and post-treatment at one year.

Results: After 1 year, exercise techniques reduced daily morphine milligram equivalent intake on average from 76.3 to 21.0 mg (p < 0.001) with 84.4% of patients decreasing their total opioid dose (p < 0.001) and 34.4% of patients being completely weaned off of opioids (p < 0.001). Numeric Rating Scale of pain and Oswestry Disability Indices were unchanged with treatment, 7.0-6.7 (p = 0.122) and 30.4-29.3 (p = 0.181), respectively.

Conclusions: The addition of a structured stretching exercise program focusing on the resolution of the myofascial pain in the treatment of "legacy pain" patients was shown to significantly reduce and often discontinue opioid use without adversely affecting pain score or functionality.

Keywords: myofacial pain syndrome; opioids; pain.

MeSH terms

  • Analgesics, Opioid* / therapeutic use
  • Exercise Therapy
  • Humans
  • Morphine / therapeutic use
  • Myofascial Pain Syndromes* / therapy
  • Pain / drug therapy
  • Retrospective Studies


  • Analgesics, Opioid
  • Morphine