We name the financial cost to the state of health issues. For many, this is unusual as human welfare is incommensurable with dollars and cents. That said, the dollar figure associated with chronic pain in Australia is $73.2 billion.
We should restate the definition of chronic pain: usually, pain is “chronic” when it lasts for more than 3 months. This condition tends to be divorced from the basic use of pain: to warn of and signal tissue damage. Chronic pain lasts beyond the expected time of healing and serves no purpose of warning. What is an unlikely weapon in the war on chronic pain? Exercise. This can feel terrible for those with chronic pain. We will discuss why exercise can be a valuable treatment.
Why exercise for chronic pain?
The effects of exercise on our emotions and our experience of pain are well understood in the common wisdom and yet are without full explanation. We hear about the runner’s high, yet what does this mean? Exercise-induced hypoalgesia (EIH) is the effect of exercise on our experience of pain, the theory that after exercise we will react with less pain to a given task, which we call the stimulus. That is, the threshold is higher. This recalls in my mind those extremely rare genetic conditions where children are born without the ability to experience pain, with disastrous effects. For sure, EIH is nowhere near as significant. We can’t charge into a burning building and rescue ten children without feeling the burns, merely because we have been for a 10km run.
An entry into the data: EIH is determined as a ratio between the severity of the stimulus before and after exercise, and in one experiment dealing with squats, EIH increased the pain threshold by 16.8% (Vaegter et al., 2018). However, in most of these experiments, not only is the mechanism of action not well understood, but the variance between results means they are mostly unhelpful. For example, the range of error on the mentioned experiment was 17%. We understand that endogenous opioids are involved in EIH. The endogenous cannabinoid system has also been nominated as a cause. What is the conclusion? Exercise works to relieve pain signals, exercise has an analgesic effect.
Exercise and sleep
Furthermore, exercise can benefit those with chronic pain as exercise betters sleep. A decline in the quality of sleep generally follows chronic pain. This may be from the pain, the worry, or even the corresponding medications, as many encourage insomnia. There is evidence that daily exercise improves sleep and this is an important step in the chain of behaviours which will combat chronic pain.
As we have earlier discussed, dealing with pain is a holistic endeavour. Many pain physicians are at the center of a web of care, whether physical, spiritual, or psychiatric, even other domains. Not sure about the value of sleep? We have all experienced that time when we have fallen through our mattress with extreme fatigue, having exerted all day, and the sleep feels deep. From the Sleep Foundation: in the 2013 Sleep in America Poll, 76-83% of those who engaged in exercise reported good sleep quality. This dropped to 56% for those who did no exercise. Fixing sleep is crucial. Exercise is a way of doing so.
What about exogenous opioids?
Another reason is that exercise is a way which contrasts well with the historical treatment for chronic pain: heavy opioids. There have been whispers and statistics of an opioid crisis in the United States, and research shows that those belonging to disadvantaged ethnic and socio-economic categories are more likely to suffer the inappropriate and excessive prescriptions. Indeed, in North America, opioids are the leading cause of unintentional death!
The analgesic mechanism of exercise may well be the endogenous manufacture of opioids. That said, exercise, especially when bounded in severity by two points above the baseline degree of pain - this is recommended as a way of evading further damage - does not carry the same risks as exogenous opioid use. It is well known that exogenous opioids have a small gap between their useful and lethal doses. Many in this space are drawing a contrast between exercise and opioids given the flaws of the second way.
How to approach and plan your exercise
Seek professional advice and support
We must ensure we consult a GP or doctor when forecasting what exercise would be best as too much can set back healing and errors can be made. Working with physiotherapists, pain specialists and health care professionals is a way of making sure we don’t bite off more than we can chew.
We can distinguish between three types of exercise: aerobic, strengthening, and stretching. The selection between these will be based on the type of chronic pain. We must find ways to exercise in daily life. These exercises do not need to conjure fear and can well be basic. Exercising every day is also considered a beneficial way to do this as the body can be coming from a big time where it has not been used and we can’t expect to do everything at once.
Apps and tech
With an increasing availability of digital tools for healthcare and medical management, websites and apps exist which can help you to gather data on your chronic pain and indeed, the exercise you may take to relieve it. These days, technology is there to wrap together your data: calories burned, duration and quality of sleep, timing of exercise, etc. Then we can gather insights into your chronic pain and the effect of exercise. For example, those with chronic pain may experience “flare ups” which are severe episodes of discomfort during exercise which can discourage continuation. To determine whether these flare ups are “hurt or harm”, that is, whether they are a fresh site of injury or merely the consequence of targeting a known area of pain, we collect data. For instance, flare ups can be caused by changes in behaviour, stress, and even the weather.
In conclusion, the crucial thing is to direct the discomfort of exercise for those with chronic pain into researching and exploring this way of treatment in a way which works for you.
Please note any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. Anodyne makes no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.
Book a consultation with one of our doctors
If you are interested to learn more about exercise therapy, please contact Anodyne to book a consultation with one of our doctors.