When you live with constant pain, even getting up in the morning can seem like too much to ask. If you find it hard to remember the last time you were free from pain, it’s not unusual for fear and depression to take hold and drag you into a downward spiral that makes the pain even worse. Even on good days, exercise can often be the last thing you feel like doing. There is evidence, however, that exercise may be one of the best ways to help manage chronic pain.
Experts have suggested several possible reasons for the pain-reducing effects of activity:
The first has to do with endorphins. These are chemicals that your body produces naturally during exercise; they have the same kind of effect as opiates such as morphine and codeine. Endorphins block the perception of pain and create a general feeling of wellness.
Secondly, regular activity helps to improve both the ease with which we fall asleep and the quality of rest once we do. Pain can become more or less easy to deal with depending on our resource levels. Most sufferers experience sleeping difficulties when their pain is bad, often prompting another downward spiral. On the other hand, better sleep means more energy and resources with which to cope with the pain.
Exercise also releases tension. Tension, stress and frustration all increase levels of pain, so anything that helps to relax the body will usually reduce pressure which inevitably leads to pain.
If the chronic pain is related to an injury, targeted exercise can strengthen the muscles around the injury site, taking pressure off the damaged tissue. Of course, the wrong kind of exercise could re-injure the original site, so it is important to get professional guidance from a physiotherapist or sports medicine practitioner rather than trying to go it alone.
Treatment for non-specific (without disease cause) lower back pain, as currently recommended by NICE, follows a step-by-step approach. The initial focus of lower back pain management tends to be on encouraging the person to remain as active as possible, with the use of short-term painkillers (paracetamol or an anti-inflammatory drug) to control pain if required. If the person does not improve, the GP may then refer them for physical therapy, such as physiotherapy or an exercise programme.
Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain. Activity also helps to stretch stiff and tense muscles, ligaments and joints, which can lessen pain.
It’s natural to be hesitant if exercise is painful and you’re worried about making things worse. But if you become more active gradually, it's unlikely you will cause any damage or harm. The pain you feel when you start gentle exercise is because the muscles and joints are getting fitter.
Choose activities that offer a range of aerobic, strength and flexibility exercises. Good choices to start with are walking, swimming, yoga and tai chi. In the long term, the benefits of exercise far outweigh any increase in pain. Also, if you avoid exercise completely, the lack of activity could lead to other problems like stiff joints, weight gain, heart disease, osteoporosis, poor balance and falls.
You may think that exercise and arthritis don’t go hand in hand but that’s certainly not the case. It was thought for many years that if you had arthritis you shouldn’t exercise because it would damage your joints. Now, however, research has shown that exercise is an essential tool in managing arthritis. Regular, moderate exercise offers a whole host of benefits to arthritis sufferers. Mainly, exercise reduces joint pain and stiffness, builds strong muscle around the joints and increases flexibility and endurance. It reduces inflammation from arthritis and related conditions and reduces the risk of other chronic conditions. It also helps promote overall health and fitness by giving you more energy, helping you sleep better, controlling weight, decreasing depression and increasing self-esteem. Furthermore, exercise can help stave off other health problems such as osteoporosis and heart disease.
Exercise is only one of many tools that can be used in the management of chronic pain and research shows that the best results seem to come from taking a multi-disciplinary approach. Medication, diet, relaxation, acupuncture, visualisation and various forms of therapy can all produce great benefits.