03 Nov Exercise right for chronic pain

Pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.

Pain is normal – it is one of the human body’s protective systems. Its intention is to alter human behaviour. Pain occurs when your brain (nervous system) concludes that there is more credible evidence of danger related to your body than there is credible evidence of safety related to your body. Equally, pain will not occur when our credible evidence of safety is greater than our credible evidence of danger.

Acute pain (also known as ‘short-term’ pain) resolves within three months, which is the duration considered to be sufficient for normal healing. Pain can occur, and persist, without actual tissue damage or harm.

Pain that persists beyond three months is known as persistent or chronic pain.

As pain persists, it is more associated with protective changes that the human body has made, and less associated with actual tissue harm. The ability of the body to change, through bioplasticity, allows these protective changes to occur over time. For example, as pain persists, the body can play the ‘pain tune’ easier because the nervous system has become more sensitive. Pain may also spread to other body parts, as whole-body sensitivity increases.

But whilst the pain system can become overprotective, the same bioplastic properties of the body can be used to re-train the pain system to become less protective. Exercise is one proven method to retrain the pain system to become less protective.

Persistent pain for older adults

For Australians aged 65-74 years, 1 in 5 will experience moderate to severe pain lasting longer than six months. Chronic pain increases with increased age.

The financial cost of chronic pain in Australia is estimated at $73.2 billion according to Pain Australia.

People with chronic pain have higher levels of depression and anxiety, higher rates of other long-term health conditions, and reduced performance of everyday life activities.

Medication use for pain

Medication is used to help treat the symptoms of pain, which can occur due to a variety of conditions such as osteoarthritis, osteoporosis, etc. If medication is required, short-term use is preferable. Longer-term pain medication use should be under the guidance of a medical professional.

Paracetamol, Aspirin, and Ibuprofen, when recommended by a GP, are considered safer, less dependent pain medications to that of opioids.

Common opioids include oxycodone, codeine, tramadol, buprenorphine, tapentadol and morphine. All opioids carry a significant risk of dependency, accidental overdose, hospitalisation, and death.

The benefits of exercise

Exercise is proven beneficial for numerous persistent pain conditions, including neck and back pain, arthritis, fibromyalgia and migraines.

Many people think about exercise benefits for pain as increasing strength, endurance or range of movement.

Exercise for people in pain also facilitates the irresistible forces of healing in the human body such as anti-inflammatory effects; releases pain management chemicals, such as endorphins, from the natural medicine cabinet of the brain; reduces the sensitivity of your nervous system; and improves your sleep quality and mood.

Types of exercise recommended

As the source of pain can vary depending on your health condition, it can be very hard to identify specific exercises to complete to assist in alleviating your pain.

Whilst standard guidelines recommend a combined total of 2.5 hours of moderate intensity exercise each week, it is recommended for people in pain to start at a baseline that can be tolerated.

This may require you to do small blocks, such as starting with 10-15 minutes at a tolerable level, once or twice a day, performing exercise that you can manage and enjoy.

It is recommended to gradually build up to perform exercise across most days of the week.

Types of exercise that are beneficial include:

• Recreational activities that you enjoy. The perceived threat to your pain system is reduced from your enjoyment and therefore physiologically better tolerated. This can include playing with children, and social exercise activities such as outdoor walking classes and excursions.

• Water-based exercise can calm and settle the sensitive nervous system due to the therapeutic properties of water. The buoyancy effects of water also better enable bodily movement that may be more difficult to perform on land.

• Targeted resistance exercise may use your body-weight, resistance bands, free weights and machines. This increases your strength to reduce the risk of falls and ability to perform everyday activities.

• Aerobic endurance exercise improves your cardiorespiratory fitness which is often reduced in people experiencing persistent pain. This may include cycling, walking and rowing on an ergometer.

• Stretching and flexibility increases the ability to move joints and body parts through and increase range and reduces tightness.

• Mind and body exercise such as Yoga and Tai Chi can improve mental well-being, balance, mobility and pain.

Things to be aware of

When in pain, it can be normal to worry or be anxious about increasing your physical activity levels or starting an exercise program. It is important to find types of exercise that you enjoy, feel confident with, and know that you are safe.

During or following exercise, if your pain levels increase to intolerable levels, you may be experiencing a flare-up. Flare-ups can be unpleasant, but do not worry, as they are normal.

During flare-ups, your overly protective pain system is protecting you before any tissue harm or damage occurs. It is creating an unpleasant experience that is trying to change your behaviour to avoid movement.

During flare-ups, it is important to keep actively moving where possible, by decreasing your physical activity to tolerable levels. Then, through repetitive, tolerable graded exercise and movement, you can gradually increase your levels. Doing so helps re-train your pain system to be less protective.

Speak to the exercise professionals

It’s important to seek advice from a qualified exercise professional to help you exercise correctly for your pain to ensure you are correctly targeting the source of pain.

Accredited Exercise Physiologists are university qualified allied health professionals trained in exercise prescription for persistent pain.

To find an Accredited Exercise Physiologist near you, click here.

Read more in the Exercise for Older Adults eBook! Download here. 

Expert Contributor: Chris Sinclair, Accredited Exercise Physiologist and Managing Director at EXPHYS®