Chronic Pain – Discussing the Relationship Between Pain and Movement

This blog explores the definition of chronic pain, the role of exercise and how Accredited Exercise Physiologists can help.

What is Chronic Pain?

Chronic pain affects approximately 3.6 million Australians, impacting daily life and mental well-being. Chronic pain is characterised by pain that lasts for more than 3 months, or in many cases, beyond normal healing time and can also be referred to as persistent pain. Unlike acute pain, which serves as a warning signal of injury or illness and usually resolves as the body heals, chronic pain can persist long after the initial injury has healed or even in the absence of any clear cause.

Pain is a complex phenomenon that involve various physiological and biochemical mechanisms. In simple terms, pain begins with our nerve cells that are responsible for detecting damage (nociceptors) being triggered by a harmful stimulus such as tissue injury, extreme temperatures and a variety of other factors. Nociceptors then send electrical signals from the damaged area along nerve fibres to the spinal cord and into the brain. Next, the brain decides how to respond to this stimulus by analysing sensory information, emotional responses and past experiences to determine the appropriate mechanism of response (may include moving your hand away from a hot fire or avoiding weight bearing on your foot after spraining your ankle). However, these pain systems and pathways can be impacted by a variety of factors which can lead to chronic pain.

Chronic pain can result from a variety of factors, including:

1. Injury: Sometimes, even after tissues have healed, the nerves may continue to send pain signals.
2. Peripheral Sensitisation: Chronic pain often involves sensitisation of peripheral nociceptors (pain-sensing nerve fibers). This can occur due to ongoing inflammation, tissue damage, or nerve injury. Sensitised nociceptors become more responsive to stimuli, leading to exaggerated pain responses even to mild or non-painful stimuli (allodynia).
3. Inflammatory Medical conditions: Conditions such as arthritis, fibromyalgia or autoimmune disorders can lead to highly sensitive nociceptors and contribute to increased chronic pain.
4. Psychological factors: Emotional stress, anxiety, and depression can contribute to the perception and experience of pain. Conversely, positive social support, coping skills, and psychological therapies can help manage chronic pain.
5. Neurological changes: Prolonged pain can alter the way nerves and the central nervous system process pain signals, amplifying the sensation of pain.

This complex nature of chronic pain highlights the importance of seeking qualified advice to assist with managing chronic pain.

Although many people living with pain avoid physical activity, prescribed exercise can be beneficial and an essential element in the treatment of chronic pain! This blog aims to focus on how exercise physiology can make a significant difference in managing and alleviating chronic pain.

Role of Exercise for Chronic Pain

Structured exercise and movement are essential components when it comes to the management of chronic/persistent pain. A variety of modes of exercise can be implemented depending on the individual to help maximise outcomes. These include Pilates, hydrotherapy, yoga, cardio activities, gym-based exercises and can be individually tailored to suit each individuals needs. Exercise produces an extensive range of benefits for managing chronic pain, including:

Benefits of Exercise Physiology for Chronic Pain:

• Pain Reduction/Modulation: Regular, supervised exercise can help reduce pain intensity and frequency.
• Improved Functionality: Chronic pain often limits physical activity and leads to deconditioning of muscles and joints. Exercise physiology focuses on restoring and improving physical function through targeted exercises that strengthen muscles, improve joint flexibility, and enhance cardiovascular fitness. This can help individuals regain functional abilities and perform daily activities with less discomfort.
• Mental Well-being: Exercise releases endorphins and serotonin, promoting a positive mood and reducing anxiety often associated with chronic pain.
• Normalisation of Central Sensitisation: Exercise can help normalise central sensitisation, a process where the central nervous system becomes more responsive to pain signals. Regular physical activity can reduce hyperexcitability of neurons in the spinal cord and brain, thereby decreasing pain sensitivity.
• Management of Comorbidities: Many chronic pain conditions are associated with comorbidities such as obesity, cardiovascular disease, and metabolic disorders. Exercise physiology addresses these comorbidities by promoting weight management, improving cardiovascular health, and enhancing overall metabolic function.
• Long-term Pain Management: Incorporating exercise physiology into a comprehensive pain management plan can provide long-term benefits by promoting sustainable changes in physical activity habits and reducing reliance on medications or invasive treatments.
• Empowerment and Self-management: Engaging in exercise under the guidance of an exercise physiologist empowers individuals to take an active role in managing their pain. Learning appropriate exercise techniques, setting realistic goals, and understanding the benefits of physical activity can boost confidence and motivation to maintain a healthy lifestyle.

How to incorporate small levels of exercise into your day

• Take a brisk walk around the block during work or lunch breaks
• Set daily reminders to exercise and stretch
• If possible, go for a walk during a phone call rather than sitting
• Use the stairs instead of the elevator
• Park your car further from shopping centres to encourage increased movement
• Complete squats or an exercise whilst brushing your teeth or during a TV commercial break
• Find a friend or family member to complete a short workout with