Exercise improves neuropathic pain: precision exercise prescription and multimodal synergy advance clinical applications

• Exercise exerts multi-target and multi-pathway regulation on neuropathic pain, including modulation of neuronal excitability, inflammation, and oxidative stress. • Precision exercise prescriptions, tailored in intensity, type, and frequency, have shown positive effects in animal models of neuropathic pain. • Exercise-induced analgesia involves upregulation of neurotrophic factors (e.g., BDNF, NGF) and inhibition of pro-inflammatory cytokines (e.g., TNF-α), along with endogenous opioid system activation. • Future research must address personalized exercise prescription design, optimal exercise parameters, and synergistic effects of exercise combined with pharmacotherapy.