Exploring management of chronic pain
Do you often find yourself reaching for pain tablets or anti-inflammatories when you can’t get your pain symptoms to settle?
If your answer is yes, you probably know how these meds can be very effective at first. But when your pain keeps hassling you over a period of weeks or months and you end up taking more than just a couple of capsules - you start to realise that they are not really making much of a difference anymore.
A recent study conducted in South Africa indicated that almost 1 in 5 adults suffer from chronic pain. Pharmacological treatment (meds) is often the treatment of choice in management of chronic pain symptoms but fails to address both the physical and psychological aspects of chronic pain. I am sure you can agree that in our fast-paced society convenience often trumps quality - which means we resort to “medicating” the problem rather than putting in the time and effort to get to the bottom of what is causing the pain. While short-term use of pain medication might often be necessary and helpful for pain relief, long term use can lead to decreased functioning and may have many detrimental effects on your health. Here are some of the most common types of medication used in pain management and how they can affect you:
Opioids like morphine act on receptors in the brain and spinal cord to help relieve pain. It is mostly indicated for short term use in acute and cancer pain. However, long-term use in the treatment of non-cancer pain is not particularly beneficial. Opioids become less effective over time and may even cause pain to become worse since it causes your nervous system to become hyper-sensitive to pain signals.
2. NSAID’s (non-steroidal anti-inflammatory drugs)
These drugs are effective in helping to decrease inflammation, especially after an acute injury. They inhibit the action of certain enzymes which help to mediate the inflammatory process. Examples include: Ibuprofen, Diclofenac and Aspirin. Research does not indicate much promise for use of these drugs in chronic pain conditions since the high risk of harm usually outweighs potential benefits. Side effects of NSAIDs include stomach irritation, bleeding from the gut and kidney problems. In most cases it is recommended that NSAIDs should only be used in short bursts.
Paracetamol can help to relieve pain and fever but does not have an effect on inflammation. It is generally safer than the anti-inflammatory group of drugs but is toxic to the liver in overdose. Paracetamol has clear benefits for use in acute and cancer pain but is not as beneficial when used for the management of chronic non-cancer pain.
Research has shown that a holistic approach to chronic pain management leads to the greatest reduction in pain. It is possible to wean and cease medication after a limited period when active self-management skills are introduced along the way. The value of physical activity as a self-management technique is often underestimated. Our bodies have its own morphine-like substance called endorphins that are released while exercising. Endorphins act in a more balanced way than its pharmacological counterparts so that pain messages can be modified without side effects. Exercise is proven to help manage pain by reducing anxiety and depression, improving physical capacity and increasing functioning and independence.
Here is what you should now about exercise and chronic pain management:
1. Aerobic exercise is a key component in managing chronic pain
This includes activities like distance running, walking, or playing soccer which involves physical work for a longer period. Aerobic exercise helps to increase the efficiency of your oxygen transportation system. This type of exercise can help to:
Increase fitness and well-being
Reduce your pain threshold
Reduce perception of pain up to 30 minutes after exercise
Influence your mood due to antidepressant effects
Tip: Start by setting small goals for the duration and intensity of exercise that you can gradually increase. “Pacing” is an especially important concept in chronic pain management.
2. Anaerobic exercise/strengthening exercises should also form part of your exercise program
This type of exercise refers to high-intensity work sustained for a short period of time with the goal of improving muscle strength.
Research has indicated that therapeutic strengthening exercises can be remarkably effective in the management of conditions like chronic lower back pain.
Your physiotherapist can assist you in identifying which exercises will help you to manage your specific condition. Since stress/anxiety is often linked to chronic pain, this type of exercise will also help you to counteract the deconditioning effect that long-term stress can have on your muscles.
3. Adding stretching and flexibility components to your exercise program can be beneficial
Activities like Pilates, Yoga and Tai Chi can help to reduce pain and improve function and spinal mobility. Exercises that focus on stretching and flexibility is not necessarily more effective than a strengthening program, but a combination of the two can be helpful for pain management.
4. When exercise is introduced as part of an interdisciplinary approach to your pain it can be more effective
An interdisciplinary approach means that different team members (physiotherapist, occupational therapist, psychologist, doctor) work together toward a common goal by addressing physical and psychological aspects. You need to be strong in body and mind to conquer the debilitating effects of pain.
So, how often should you be exercising?
World activity guidelines for people aged 18-64 recommend at least 150 minutes of moderate-intensity exercise per week, or 75 minutes of high-intensity exercise (it can also be a combination of the two). This can be increased to 300 minutes per week for additional benefits. Note that aerobic exercise should be performed for at least 10 minutes at a time. Another good guideline is to do strengthening exercises involving all the major muscle groups at least 2 days of the week.
Management of chronic pain is not an easy feat, but with the guidance of your physiotherapist at Christiaan Moolman Physiotherapy Inc. and a holistic approach, we can work together to give you a better quality of life.
“Meds” definitely has its place in chronic pain management when it is used correctly for the appropriate amount of time, but do not underestimate the benefits of “Reps” and your body’s inherent ability to combat pain.
Sullivan A.B. et. al., 2012. The Role of Exercise and Types of Exercise in the Rehabilitation of Chronic Pain: Specific or Nonspecific Benefits. Curr Pain Headache Rep, Volume 16, pp. 153-161.
Pain and Physical Activity, n.d. Pain Management Network. [Online] Available at: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/212848/Pain_and_Physical_Activity.pdf [Accessed 12 July 2020].
Kamerman P.R. et. al., 2020. Almost 1 in 5 South African adults have chronic pain: a prevelance study conducted in a large nationally representative sample. Pain, 161(7), pp. 1629-1635.
Hunter Integrated Pain Service: Chronic Pain and Medication, 2013. Pain Management Network. [Online] Available at: https://www.aci.health.nsw.gov.au/data/assets/pdffile/0011/212213/ChronicPainandMedication1.pdf [Accessed 12 July 2020].