Exercise for people living with chronic pain

By Nanny Eliana

When done correctly exercise can improve pain and the quality of life for patients living with chronic pain, yet patients are reluctant to exercise.

Exercising with pain might sound counterintuitive for patients who suffer from chronic pain. However, reducing exercise can in fact worsen, rather than improve the condition of patients living with chronic pain, such as those who have been diagnosed with osteoarthritis, complex regional pain syndrome, cancer, fibromyalgia, spinal pain and chronic neck and back pain.

Dr Leong Kok Cheong, Darren, Senior Staff Registrar, and Adjunct Assistant Professor Ivy Lim, Consultant from the Sports Medicine Department of Singapore’s Changi General Hospital shared with us the benefits of exercise for patients living with chronic pain and navigating the challenges in getting them to comply with their prescribed exercise plans. Both of them will be speaking at the MEDICINE + SPORTS conference at MEDICAL FAIR ASIA 2018 which will be taking place from the 29^th to 31^st of August at Singapore’s Marina Bay Sands.

Chronic pain is a burden on the patient’s bodily systems, resulting in functional decline, anxiety, depressed mood and immune system, poor concentration and memory, and disturbed sleep. There is a growing body of evidence that exercise is essential in reducing the severity of pain and improving function as well as the quality of life of patients with chronic pain. Personally involving and empowering patients in the management of their pain will increase their self-efficacy, or belief in their ability to accomplish tasks. Coupled with the benefits to cardiovascular and bone health, exercise can improve the patient’s overall quality of life, while reducing the burden on healthcare resources.

Dr Leong said that patients can expect to glean physical benefits as well as a sense of well-being from an exercise plan that is correctly prescribed for and undertaken by patients with chronic pain, “Benefits include the easier gliding and lubrication of the joints, making for increased joint mobility, and increased muscle strength, balance and endurance. Exercise also improves the function of nerves and intervertebral discs as movement facilitates bodily structures in their acquiring of nutrients.”

“Endorphins, which are the body’s natural painkillers are released during and after exercise, increasing pain tolerance for up to an hour depending on the exercise, and brings about a sense of relaxation when the nervous system winds down, which modulates if not reduces anxiety and depression. Exercise is also anti-inflammatory and reduces the incidence of flare-ups in inflammatory conditions such as osteoarthritis.”

Adjunct Assistant Prof Lim says that it is possible for patients with osteoarthritis and other forms of chronic pain to reduce painkiller intake with suitable exercise. “Medication such as anti-inflammatories help in situations when the pain is inflammatory, for example when there is a flare of osteoarthritis, or in autoimmune conditions. In osteoarthritis and other joint pains, weight loss that may occur with exercise can help reduce forces across a joint and thus reduce pain and the need for painkillers. Addressing modifiable factors such as muscle weakness, inflexibility of muscle imbalance with exercise may also help to reduce the abnormal loading of a joint, hence reducing pain.”

However, in spite of the benefits, it might seem counterintuitive for patients with chronic pain to exercise. Adjunct Assistant Prof Lim explains, “In addition to lack of time and facilities, patients do not find exercise appealing as they often fear injury or aggravating an existing injury. Doctors may not have the relevant expertise to evaluate if the pain is due to overload or injury from exercise. To err on the side of caution, doctors may advise the patients to avoid exercise altogether.”

For patients to fully benefit from exercise, it is essential that physicians take into account how patients perceive their chronic pain when prescribing an individualised exercise plan. Says Dr Leong, “Chronic pain is best treated actively through the development of effective coping strategies to manage and cope better with symptoms rather than passive treatment. The patient should be approached holistically and prescribed exercise plans that do not just help with the pain but also improve underlying conditions.”

Adds Adjunct Assistant Prof Lim, “A multidisciplinary team which can include allied healthcare professionals such as physiotherapist, occupational therapists, psychologists and so on, led by a trained exercise physiologist or doctor, should take the time to thoroughly examine their patients’ conditions and their concerns when prescribing exercise plans for their patients.”

According to Dr Leong, reducing anxiety and reassuring patients and their caregivers about the benefits of exercise is an essential part of encouraging patients to exercise, “Most patients with chronic pain still exercise. This is why physicians must educate and reassure patients and their caregivers that pain does not equate into further injury. Patients and their caregivers must also be guided on what is acceptable and non-acceptable pain as it is normal for patients with chronic pain to experience discomfort and/or increased symptoms as they become more active.”

“Exercise should include cardiovascular exercises such as walking and swimming and should be started slowly and then slowly increased in volume, before intensity. It should also be closely supervised initially. Patients must also heed the advice not to overdo exercise on good days when they feel less pain and not do less on bad days when pain is worse.”

“To improve compliance, it is important that exercise is fun and enjoyable, and prescribed according to a patient’s preference — such as whether the patient prefers to exercise in a group or alone. Regular follow-up with gradual progression of exercise would also help,” elaborates Adjunct Assistant Prof Lim.

Click on https://www.medicalfair-asia.com/pdf/MFAMSC-Program-Booklet.pdf to download the MEDICINE + SPORTS conference programme.

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