Exercise and Chronic Pain

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What is the definition of "chronic pain"?

Everyone feels pain differently and nobody can know what somebody else's pain is like. Defining pain, therefore, is very difficult. A widely used definition of pain has been devised by the International Association for the Study of Pain (IASP):

Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

Pain is usually identified by two types:

Acute pain is a normal sensation that alerts us to a possible injury. It typically lasts until the tissues have healed after an injury; it is directly related to soft tissue damage ². Acute pain is of relatively short duration and it will end once the injured tissues have healed. However, it can lead to chronic pain.

Chronic pain has many variations: The intensity can be anywhere from mild to excruciating. It can occur every day, or there can be breaks. It may be inconvenient one day and nearly incapacitating the next. It can be in the same area every single day, or it can change from day-to-day.

Chronic pain is sometimes defined as any pain which lasts more than three months ³. It is described in various ways — shooting, burning, and aching are three of the most common words used — or it may be a feeling of discomfort, soreness, tightness, or stiffness. Chronic pain takes both a physical and emotional toll on the person suffering from it.

Some people have conditions that should cause great pain, but don’t. Others have no sign of a physical problem, but are in a great deal of pain. Unfortunately, a person's level of chronic pain can not easily be assessed.

To help compensate for this, many professionals ⁴ rely on pain scales in which the patient is asked how severe the pain is with 1 the least painful and 10 the most painful. They might seem too simple to be useful, but "pain scales have a lot of good research behind them," says Steven P. Cohen, MD, associate professor in the division of pain medicine at Johns Hopkins School of Medicine in Baltimore. "Chronic pain is often now considered a serious condition in itself; thus, pain scales have become an important tool to evaluate and monitor pain."

What conditions might cause chronic pain?

Some people suffer chronic pain in the absence of any past injury or evidence of body damage.

Chronic pain often begins with acute pain. This would include headaches, joint pain, pain from injury, and backaches. Unfortunately, acute muscle or nerve pain can develop into a chronic condition because pain signals can remain active in the nervous system for months or even years. If an initial injury doesn't get better, there's a good chance it will develop into chronic pain.

Some of the more common medical conditions that can lead to chronic pain are:

• Fibromyalgia;
• Rheumatoid Arthritis;
• Osteoarthritis;
• Low Back Pain;
• Headaches, including migraines;
• Shingles;
• Multiple Sclerosis; and,
• Carpal Tunnel Syndrome.

What happens to those who suffer from chronic pain?

Chronic pain can bring on other serious problems:

• anxiety;
• stress;
• depression;
• anger;
• insomnia and fatigue; and,
• withdrawal from activities.

Because there is a link between pain and the brain, these conditions interact in complex ways, such as:

• It may decrease the body's production of natural painkillers.
• Negative feelings begin a vicious cycle and, as a result, the substances that amplify sensations of pain will increase.
• Unrelenting pain can suppress the immune system.

Effective treatment, then, requires addressing psychological as well as physical aspects of the condition.

If you are in pain, should you exercise?

If you have a sprained ankle, or are suffering from any acute pain, some types of exercise are clearly not the answer. You should not run in a marathon if your ankle is sprained. But could you sit in a chair and lift weights? Yes, you could. Would it help your overall emotional and physical state? Most likely.

If you are in chronic pain, you probably do not want to exercise. But, ironically, in many cases, exercise will help — and research is proving this. Exercise can also help improve function of joints, so in the long run, exercise could be very helpful in alleviating chronic pain.

What kind of exercise you choose, and how often you choose to do it, depends on how much pain you are in, where the pain is located, and how long the pain has been affecting you. Chronic pain sufferers have to consider what kind of exercise they will do and how often.

What exercises are helpful to those who are in chronic pain?

Here are some of the best activities for those who are dealing with chronic pain:

• Walking: Go at your own pace and choose a walking route that is easy at first (level, if possible). Don't venture too far from home, but make sure you have enough energy to return! As you feel better, you can increase the distance and the pace.

• Swimming: The advantage to swimming is that it puts less pressure on your joints. If you have access to a pool, swimming is great exercise for someone who is dealing with chronic pain.

• A mild fitness class: Many fitness classes are intended for the very fit young person. Look for a class that is intended to be low-impact cardiovascular exercise and strength training — or a chair class where most exercises are done while sitting. If you attend a class, do only what you can. If you are unable to be comfortable with it, choose your own movements. Talk to the instructor (who should be well-versed in chronic pain issues and/or older adult issues) about your personal situation.

• Stretching: You can do this at home, or you might be able to find a tai chi or Hatha yoga class intended for older adults. As well, many fitness classes for older adults will include a stretching session.

• Strength Training: Research is revealing that strength training is equally as important as cardiovascular exercise — if not more so. You may be able to find a class for this — one that just does strength training or one that has all elements of fitness but includes strength training. You could also go to a gym and try doing your own exercises, but you might want a personal trainer to assist you.

• Daily Activities: Don't forget the many things that you can do right at home. This includes everything from small household chores to gardening or working on your hobbies.

Once you have decided to exercise, take it slowly. Those who exercise to improve their fitness level usually need strenuous and continuous activity on a regular basis. Those who exercise to gain health benefits such as pain control, however, can achieve it through moderate-intensity activities throughout the day.

What does the research say about chronic pain and exercise?

The research about chronic pain and exercise is somewhat limited, even though it's been known for quite some time that some exercise can be very beneficial for those who suffer from chronic pain. Here is a look at three studies:

Study 1: Chronic Pain Prevents People from Exercising

This study concluded that chronic pain itself prevents people from exercising: "Pilot studies and a literature review [suggest] that fear-avoidance beliefs about physical activity and work might form specific cognitions intervening between [chronic pain and the willingness to exercise.]" The researchers suggested that fear of creating more pain by exercising prevents patients from trying to do any form of exercise, even if they are told that it will help to exercise.

Study 2: Chronic Pain patients tend to Exercise Less

Another study begins with the assumption that "Chronic pain patients typically display reduced activity level attributed to pain and implying a positive correlation between exercise or activity and pain complaints." After studying many other scientific reviews, they concluded, "Chronic pain patients typically display reduced activity level attributed to pain and implying a positive correlation between exercise or activity and pain complaints."

Study 3: Exercise can be an Effective Treatment for Chronic Pain but it must be Tailored to each Individual

This study suggests that exercise can help with dealing with chronic pain. They began their research with the following assumption: "Exercise is an effective treatment for various chronic pain disorders, including fibromyalgia, chronic neck pain, osteoarthritis, rheumatoid arthritis, and chronic low back pain. Although the clinical benefits of exercise therapy ... are well established [through evidence-based research], it is currently unclear whether exercise has positive effects on the processes involved in chronic pain."

The conclusion of this study was: "A dysfunctional response of patients with chronic pain and aberrations in central pain modulation to exercise has been shown, indicating that exercise therapy should be individually tailored with emphasis on prevention of symptom flares."

The research certainly reveals that those who suffer from chronic pain are very fearful of exercise. The research also reveals that exercise can help. Patients with chronic pain first have to overcome their fears of hurting more because of exercise — and then finding an appropriate exercise for them. Each person has to find the right balance for their particular situation.

This article is part of a series about various health conditions and the benefits of exercise. The other articles are:

• Exercise and Allergies
• Exercise and Arthritis
• Exercise and Asthma
• Exercise and Balance
• Exercise and Cancer
• Exercise and Circulation
• Exercise and COPD
• Exercise and Dementia
• Exercise and Diabetes
• Exercise and Heart Disease
• Exercise and Hypertension
• Exercise and Lifestyle and Older Adults: Recent Research
• Exercise and Mood
• Exercise and Osteoporosis
• Exercise and Our Brain
• Exercise and Pain vs. Burn: Will it ever stop hurting?
• Exercise and Parkinson's
• Exercise and Sleep
• Exercise and Stroke
• Exercise and Viruses: Exercise Immunology

I am a BCRPA-certified fitness instructor in Vancouver, BC. I teach four classes at the West End Community Centre in Vancouver, BC, mostly designed for the older adult. The Inevitable Disclaimer: Everything published here expresses only my opinion, based on my training and research. What you do with the information is entirely your own responsibility. I am not liable for any injury you suffer that seems to be related to anything you read here. Always consult your doctor before beginning an exercise program. For other articles, return to the table of contents.