Pain assessmentsOverall, both inter

Pain assessments
Overall, both interventions led to an alleviation of pain
intensity over time, reflected in steadily decreasing VASscores
before and after training. This has already been
shown for strength training interventions [58] and is
herewith presented for the first time for RAGT. If pain
intensity was averaged over all sessions and subjects
(RAGT: before training: 28.6 ± 3.0% and after training:
24.1 ± 3.3%; strength training: before training: 29.6 ±
2.6% and after training: 22.8 ± 3.6%), this equaled in a
mean short-term pain reduction of 15-23%. It must be
noted though that in this gait-unrelated outcome measure,
strength training seems to have had a larger impact
compared to RAGT as there was a significant difference
between the changes in scores of mean pain intensity.
Nevertheless, we can conclude that neither strength
training nor RAGT worsened the general perception of
pain. This is particularly important for the Lokomat as it
obviously can be adapted to the physiology of the users
without overstraining their musculoskeletal system.
We did not investigate pain-relieving effects within a
specific type of pain because we had only a small number
of subjects, and some of these subjects experienced
both musculoskeletal and neuropathic pain. In our opinion,
it might be less relevant as there is evidence that
physical activity can have positive effects on neuropathic
as well as on musculoskeletal pain. With respect to
neuropathic pain, several studies suggest that physical
activity could have a positive influence on impaired sensory
function [14,59-61]. It has been shown in animals
that treadmill running has positive effects on nerve regeneration
and functional recovery after peripheral nerve
injuries [62,63], which are known to cause neuropathic
pain [64]. Further literature shows that physical activity
can also reduce musculoskeletal pain [65,66].

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