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The Relationship between Exercise and the Improvement of Chronic Pain

Changes to Pain Management Procedures During the COVID-19 CrisisRaj N. Sureja, MD

Chronic pain is a condition that affects millions worldwide, often leading to significant physical, emotional, and social burdens. Traditional approaches to managing chronic pain have primarily focused on pharmaceutical interventions and physical therapies. However, emerging evidence suggests that exercise can play a crucial role in alleviating chronic pain symptoms and improving overall quality of life. As an Interventional Pain Management Physician, I’d like to highlight the potential of exercise as an effective and safe adjunctive therapy for chronic pain management.

First, let’s define chronic pain as a complex condition which is characterized by persistent pain lasting beyond the expected healing time. It can arise from a multitude of causes, such as musculoskeletal disorders, neuropathic conditions, or other systemic diseases.

Exercise Produces Natural Pain Relievers and Mood Enhancers

The mechanisms by which exercise exerts positive effects on chronic pain are multifaceted. Exercise promotes the release of endogenous opioids, such as endorphins, which act as natural painkillers and enhance pain tolerance. Additionally, regular exercise increases the production of neurotransmitters like serotonin and norepinephrine, which are involved in pain modulation and mood regulation. Exercise also promotes neuroplasticity, leading to structural and functional adaptations in the central nervous system, resulting in reduced pain sensitivity and improved pain coping mechanisms.

What Types of Exercise Are the Best?

Various types of exercise have shown efficacy in improving chronic pain conditions. Aerobic exercises, such as walking, swimming, or cycling, have demonstrated analgesic effects through their ability to improve cardiovascular fitness, enhance blood flow, and release endorphins. Resistance training, including strength and resistance exercises, has been shown to increase muscle strength, improve joint stability, and reduce pain in conditions such as osteoarthritis. Mind-body exercises, including yoga, tai chi, and qigong, combine physical activity with relaxation techniques, promoting stress reduction, improved sleep, and pain management.

Impact on Pain Perception and Functionality

Numerous studies have provided evidence for the beneficial effects of exercise on chronic pain management. Exercise interventions have been shown to reduce pain intensity, increase pain threshold, and improve pain-related disability in individuals with chronic musculoskeletal pain, fibromyalgia, and neuropathic pain. Moreover, exercise can enhance physical functioning, promote better sleep patterns, and improve psychological well-being, including reduced anxiety and depression symptoms.

What to Consider First

While exercise is generally safe and effective, it is important to talk with me (or your pain management physician) about the exercise you want to do, taking into account the specific chronic pain condition, physical capabilities, and limitations you have with your chronic pain condition.  If you’ve never skied downhill before, now is not the time to start.  We want to find an exercise that will bring you pain relief benefits, not cause you to potentially break a leg on your first run.

How Can I Exercise When I Hurt so Badly?

Sometimes, it is simply convincing ourselves that making the effort will allow us to reap the rewards of pain relief. I typically recommend slow and gentle exercise that is easy on the body to start, with short periods of exertion at first, to allow your body to become accustomed to the stress.  You will soon find that your body responds positively to your workouts, and you will be encouraged to do more.

Exercise represents a promising and non-pharmacological approach to alleviate chronic pain symptoms and enhance the overall quality of life for individuals suffering from chronic pain.  Ultimately, it can provide you with a pathway towards a better quality of life.

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