Chronic pain takes a toll on your body, mind and soul. Often times, you may feel like you have little control over what's going on with your body or your medical situation. You may feel helpless and hopeless, at the mercy of what you may perceive to be — and sometimes are — indifferent health care providers and chronic pain.
Unfortunately, there often is no magic pill or cure to relieve chronic pain. Medications and surgery may not be enough, especially for pain that has lasted months or years. Relieving pain and improving function requires work both on the part of the physician and on the part of the person in pain. People with chronic pain must be active participants in their care, and one aspect of this is caring for your body, mind and soul.
We've heard it all before — get a good night's sleep, eat a healthy diet, and exercise. These are vitally important to maintaining function and health. It's hard enough to take care of yourself when you're healthy. It may seem impossible to do these things when you're in pain. Pain may prevent you from falling asleep or it may interrupt your sleep. It may prevent you from standing and preparing healthy meals or the pain may make it impossible to move.
It's a catch-22—you're in pain, so you don't want to move, or you're finally feeling a little better, but you're afraid to move because your pain might come back. This leads to the pain cycle of avoidance, de-conditioning, tightness, and ultimately more pain. Moving is what the human body is designed to do. Avoiding exercise is harmful to your physical and mental health — you lose muscle tone and strength, your heart and lungs work less efficiently, and your pain can increase.1
Incorporating appropriate activity into your lifestyle, on the other hand, may have immeasurable benefits to your physical and mental well-being. Such benefits include increased muscle strength and flexibility, which means more support for your bones, improved sleep, stress relief and sometimes even pain relief.2
People with chronic pain often will say that they used to be active, mobile, and energetic, but now find that their pain makes many activities very difficult, if not impossible to do. Your doctor or physical therapist can help you determine which type of exercise or combination of exercises will help you regain your fitness level, muscle tone, and flexibility. They also will help you do it in a slow, and yet progressive fashion.
Types of Exercise
There are three categories of exercise — aerobic, strengthening and flexibility.
Aerobic
Aerobic means any form of exercise that increases the heart rate for a prolonged period of time. Aerobic exercise has been found to be one of the most beneficial forms of exercise since this type of exercise rebuilds the stamina and energy that you lose from inactivity. Examples of aerobic exercise include walking, biking, and swimming. There is no one form that is better than another, although there are some conditions you should consider when determining which aerobic exercise may be right for you. For example, if you have worn-out knees from wear and tear over the years, then you should avoid an exercise that is hard on the knee joints, such as jogging. You should try something with less weight-bearing through the knees, like swimming. For certain types of back pain, walking is an excellent option.
Experts recommend 20 to 30 minutes of non-stop aerobic exercise as a long-term goal. To safely work up to 20 or 30 minutes, start out with 2 to 5 minutes at your own brisk pace. This is fast enough to get the heart rate up a small amount to challenge your heart and lungs. You should ask your doctor or physical therapist about what target heart rate is appropriate for you. Experts also encourage a 1 to 2 minute "warm-up" and "cool-down" on both ends of the aerobic exercise. This simply means to start out at a slow pace to warm-up your body before speeding up to your brisk pace and then slow down at the end to cool your body down. Increase the aerobic portion (the 2 to 5 minutes) by 1 minute every week. It will take you a long time to reach the 20 to 30 minute goal, but this is a very safe progression. This aerobic exercise should be done 4 to 5 times per week. Aerobic exercise performed 3 days a week, on the other hand, is a maintenance routine, and your progress will be minimal.
Flexibility
Flexibility is another form of exercise that can help reduce pain and help your body move better. Flexibility exercises include stretching and range-of-motion exercises, which are particularly helpful for people with fibromyalgia, arthritis, and complex regional pain syndrome. The old statement, "if you don't use it, you lose it," is true when it comes to muscles, tendons, and ligaments. They stiffen up and tight muscles are uncomfortable muscles. You can actually decrease pain by increasing flexibility. Ask your doctor or physical therapist which stretches or range of motion exercises will benefit you. Stretches should be done daily, but remember to go about all of these exercises slowly, gently, and yet progressively. Stretching before aerobic or weight training also helps prevent sore muscles.
Strengthening or Resistance
Increasing your lean muscle mass is vital to supporting your bones. Strength training or resistance exercise increase muscle mass and even help decrease the risk of osteoporosis (a disease that causes the bones to become fragile and more likely to break). It can help your coordination and balance, and can help prevent injuries resulting from weak muscles. You will burn more calories as you increase your muscle mass. Maintaining a healthy weight may help your pain as a healthy weight means your joints support less weight. It's important to have proper posture when performing strength training so be sure to talk to your doctor or physical therapist about the most appropriate resistance or strength exercises for you and your pain condition.
Exercise and Chronic Pain
It's frightening to start something new, especially if you feel like all you do is try a new medication or a new procedure or a new therapy. Exercising is something you can do to help you feel more in control of your physical condition. Exercise also may help you improve your pain, as it releases endorphins, a type of neurotransmitter. These endorphins interact with neurons and reduce the intensity of pain.
Following are some suggestions for increasing your activity level:
- Choose exercises that can be incorporated into your daily routine and that you enjoy. Many forms of exercise are fun and help you enjoy the outdoors or time with a partner or friend, including bicycling, low-impact aerobics, dancing, golf, walking, water calisthenics, yoga, or tai chi.
- Make exercise a priority by setting a schedule and sticking to it. Eventually, exercise will become a routine in your life — something that you'll miss if you skip a day.
- Ask your doctor about appropriate exercises and activities for your situation.
- Set appropriate goals.3 No goal is too small—visiting friends or walking around the block may be appropriate goals, depending on your pain and physical condition.
- Listen to your body and don't force it to do something that is painful, such as sitting cross-legged for yoga.
- Be gentle to yourself, both physically and mentally. Don't beat yourself up if you miss a day or a week or a month. Each day is a new day and you can start again.
References
- "Chronic pain: Exercise can bring relief," Mayo Clinic (July 27,
2005). Available from
http://www.mayoclinic.com/invoke.cfm?objectid=52C9BFFF-E4BA-4844-A9060067887FFDD4; M Nicholas et al, Manage your Pain: Practical and Positive Ways of Adapting to Chronic Pain (Sydney: ABC Books, 2002) 84-89, 98-127.
- "Chronic pain," WebMD (March 2001). Available from
http://my.webmd.com/content/article/1832.50232/ ; "Chronic pain: Exercise can bring relief," Mayo Clinic (July 27, 2005).
- "Chronic pain: Exercise can bring relief," Mayo Clinic (July 27, 2005); Nicholas et al, Manage your Pain: Practical and Positive Ways of Adapting to Chronic Pain, 84-89, 98-127.
Information in this article was adapted from the following areas on
www.NationalPainFoundation.org:
More information on the benefits of exercise —
