Persistent pain is deemed chronic when it has lasted more than 3 months, or more than its normal healing time. Chronic pain is a complex condition and experienced by everyone differently. There are many different causes of chronic pain, including an injury that is not healing properly, an illness like cancer or arthritis, or some people experience chronic pain with no evidence of illness or injury. The most common forms of chronic pain include Arthritis and joint pain, back pain and neck pain.
Pacing means finding an achievable amount of physical activity given your current level of fitness and pain. It is not under-doing or over-doing exercise but working at a level between the two.
A flare-up is an episode of chronic pain that is more intense than usual. It may be described as feeling like muscle cramps or spasms, electric shock or shooting pain, for example.
Pain management is all about utilising neural plasticity to re-program and reduce the over-active danger signals in the brain and nervous system. What each individual needs for reprogramming may be different.
Functional exercises often look similar to movements you would make in daily life, for example; picking up a heavy object, walking up stairs or carrying groceries.
Exercise for Chronic Pain
Along with reduction of medication, slowly paced functional movement is recommended and can help with an individual living with chronic pain and their daily living activities, as well as improve quality of life.
Some people with persistent pain markedly reduce physical activity because it hurts. Others push through pain and may overdo their activity. This generally flares pain up and the increased activity becomes hard to sustain. Some overdo their movement when their pain level is relatively low and then stop activity when pain flares. This sets up an unhelpful cycle of rest and overactivity. Then within a short space of time muscles tighten, joints stiffen and there are many negative effects on cardiovascular fitness, mood and wellbeing.
Pacing is about planning small amounts of regular physical activity to avoid too much or too little exercise. This is essential when treating chronic pain. Pacing involves commencing a daily activity routine that is easily achievable. The activity can then be gradually increased over time. Pacing can be used for any type of physical activity including Activities of Daily Living (ADLs), hobbies, work duties and specific exercises. Pacing activity will reduce the chances of flare ups that can cause significant psychological effects on a person's ability to complete tasks. It can also prevent fear avoidance of tasks that are thought to produce pain.
A well rounded program of exercises should include activities that keep the body flexible (gentle stretching of the whole body, not just painful areas), Strength training (lifting light weights or carrying the shopping) and cardio training (walking, swimming etc).
The Role of Neuroplasticity in Pain Management
The benefits of small amounts of consistent exercise for people with chronic pain are substantial through both the body and brain. With chronic pain, the nervous system can become heightened or super-sensitive. A heightened nervous system is caused by neuroplasticity which increases the number of connections and signals around the brain and spinal cord, and because of this, pain can even be felt without moving and with just thoughts alone. Some people with chronic pain can experience a memory or ‘echo’ of their original pain, without any evidence of anything physically wrong.
Pain management aims to reprogram the way the nervous system interprets pain and responds to danger signals through utilising neuroplasticity. Improving your function through small amounts of regular physical activity is recommended to retrain the brain and nervous system in the way it interprets and responds to pain.
What to do next
— Begin by learning about your pain from your doctor or Exercise Physiologist. You will need to actively work with your health provider to explore new ways to get moving again - despite your pain.
— Think about the things you enjoy or did enjoy doing and brainstorm ways with your EP to gradually introduce them into your normal daily routine
— Increase frequency slowly and in consultation with your EP