Combating Chronic Pain with Exercise
By Christopher Sahler, MD
Common sense tells us to take it easy when we feel pain. That’s the wise course of action if the pain is caused by an injury such as an ankle sprain or muscle tear. For people suffering chronic pain, however, it appears that the opposite is true. A growing body of research indicates that a regular program of physical activity can help keep chronic pain under control.
An estimated 100 million Americans suffer from some degree of chronic pain. It is a more common ailment than diabetes, coronary heart disease and cancer. Unlike acute pain, which is a normal sensation triggered by an injury to the body, chronic pain results from a hyperactive nervous system that sends continuous pain signals to the brain, even if there is no apparent injury. It can affect any and all parts of the body, although the lower back, neck, shoulder and knee are most commonly afflicted. While pain from injury usually resolves once the body is healed, the constant, gnawing ache from chronic pain can go on for months or even years.
Prolonged pain often leads to depression, anxiety and loss of sleep. For some, the intensity and unrelenting nature of the pain makes it difficult to think of anything else. Relationships suffer and productivity at work declines, if it is possible to work at all. People with chronic pain are often afraid to move too much out of fear that they will make the pain worse, but staying still is the worst thing you can do, as studies show.
Inactivity leads to weight gain, muscle atrophy, loss of mobility and a sense of helplessness. In an Italian study of chronic low back pain, people who underwent a 12-month program of physical activity improved their overall health and pain levels over the group that did not participate in the program. Elsewhere, 61 randomized controlled trials of 6,390 participants concluded that exercise was effective in decreasing pain and improving function in adults with chronic low-back pain.
One of the reasons exercise is an effective pain management tool is because it releases endorphins—brain chemicals that improve mood and act as natural painkillers. Exercise provides the additional benefits of increasing a person’s agility and range of motion. It strengthens muscles and reduces the risk of injury. Being able to manage chronic pain has profound psychological impact as well. You no longer feel like a victim of your own body.
If you’ve been held back by lingering pain, it’s important to consult with your physician about which types of exercise are most appropriate for your condition. In some cases, a multi-modal approach may be needed to help get you back on your feet. Non-opioid treatments such as acupuncture, medications such as Tylenol and NSAIDs, physical therapy, or nerve block injections can help bring your pain to a manageable level, but a continuous program of exercise will help keep the pain at bay for the long haul.
The type of exercise that will be most effective will vary from person to person, but moderate aerobic exercise, core strengthening and resistance training have proven effective for people with lower back pain, fibromyalgia and certain neck conditions. Aquatic exercise and quadriceps strengthening can reduce knee pain and its recurrence. Overall, swimming, aqua-aerobic classes and riding a stationary bike are all good sources of gentle aerobic exercise. Stretching, yoga, Pilates, tai chi, and breathing exercises are helpful because they increase blood supply and nutrients to the joints, reduce stress to the muscles and improve coordination and balance.
As with most other hurdles in life, getting your life back in motion is a process. You can’t expect to go from 0 to 60 right away. Get started with gentle, slow movement like a few simple stretches, a few strokes in a pool or a two-minute walk that you increase by one-minute increments twice a week, for instance. Gradually increase the length of your exercise time or the frequency that you exercise over the course of several weeks or several months. Don’t shoot for an hour power walk the first time you set out. You also need to accept that there will be setbacks along the way. Some days may seem impossible due to pain or fatigue.
Listen to your body. While some fatigue and soreness is normal when starting an exercise program, ramp down your activity or switch it altogether if it increases any of your symptoms. Conversely, don’t let a feeling of well-being lead to overexertion. Although it’s tempting to do so, you’ll only risk aggravating your pain. The important thing is not to let too many inactive days accumulate. If that happens, you should check in with your physician.
While exercise can reduce and control chronic pain, in most cases it doesn’t eliminate it entirely. Curing chronic pain or becoming completely pain-free is unrealistic in many chronic pain conditions. But with the help of other non-opioid treatments, you can reduce your pain to a manageable level so that you can perform the activities of your daily life with greater ease and comfort and return to the recreational activities that you enjoy.
Christopher Sahler, MD, is an interventional physiatrist and pain management specialist at ONS in Greenwich and Stamford who focuses on non-operative treatment of pain and musculoskeletal injuries to restore proper function and active lifestyles. He will be speaking on chronic pain at Greenwich Hospital on March 10 at 6 p.m.