Chronic Pain

Contrary to popular belief, gentle exercise is one of the most important parts of managing pain. A lot of people worry that exercise will make their condition worse. We associate post-exercise pain as harmful and this isn’t always the case. Lots of people are also put off as they are unsure of where/how to start or they’ve had a bad experience in the past.

Research tells us that gentle exercise is good for people with chronic pain because it can:  

• improve strength, stamina and flexibility
• improve your overall health 
• can benefit your emotional health
• releases endorphins into the system.  These are natural pain killers and “feel good” hormones
• helps with balance and coordination
• helps improve sleep
• helps with joint health – “If you don’t move it, you lose it”

Above all else, the exercise you do should be something you enjoy and are more likely to continue with long term. There are links at the bottom of this page to institutions that can help or assist someone wanting to increase their exercise levels, as can your Physiotherapist and GP.

Any exercise should be started very gently and very gradually increased over time, as long as no adverse reactions are being noted. Start too fast and you’re likely to suffer a flare up which will put you off continuing with the activity. A gradually increasing approach will increase your own self confidence in the activity and help you achieve your own “lightbulb moment” where you realise “I can do this”.

With Chronic Pain it is important to remember that Flare ups are normal. They will happen to everyone. What varies is how often (Frequency) and how much they affect the person (Severity and Duration). They can last a few hours, few days or even a few weeks. They can be worrisome initially but it is not an indication that the underlying condition has worsened and definitely not a cause for panic. The goal is to continue as normally as possible and over time work to shorten the duration and reduce the frequency and severity.

Flare ups can be caused by many reasons; sometimes being a little overzealous with day to day activities, a change to work or home situations, a change to or missing medication. So some self reflection is important to try and identify potential “triggers” of your flare ups. Once you have an idea of what is causing them, then you can make changes to avoid these in the future.

Other tips that can help:

• Balance between exercise and rest – Its important not to undo all the hard work you had previously put in in terms of exercise, but obviously the increased pain levels mean that you wont manage quite as much as previous. The temptation is the stop altogether, but this can often prolong the duration of the flare up. Instead, continue with gentle exercise where possible and balance it with regular rest breaks as well as pacing activities so you don’t “over-do it”.
• Medication use – Although managing medication should be applied all the time, its important during a flare up that you keep up with regular dosages as it help to reduce the severity and duration of the flare ups, while also helping to allow you to continue the exercise.
• Positive Thinking – Remember that a flare up is temporary and not an indication that anything has worsened. Stick with the advice and you will come out the other side fine.
• Socializing – Make arrangements and see friends/family, go on a walk etc. Social interactions act as a distraction from our pain but can also help release endorphins which make us feel better and reduce pain.
• Relaxation – Can have positive effects both physically but also psychologically. Practicing Yoga and Meditation is something that’s advised to help manage chronic pain in general but again can be especially important during a flare up

Again this can be a double-edged sword. Pain can affect our ability to have a good night sleep, but disturbed sleep can also have a negative impact on our pain, or more specifically out brains interpretation of pain signals.

It is helpful to put some good practices in place to help us have less disturbed/broken sleep, help us get to sleep in the first place and reduce our experiences of tiredness and fatigue during the days. These can include:

• Regular bed times so that your body gets used to “switching off” at certain times
• Relaxation in the evening, quiet activities rather than adrenaline inducing activities
• A warm, relaxing bath
• Avoid caffeine and alcohol towards the end of the day
• Taking medication as prescribed
• Increased activity levels during the day will help you sleep better at night
• A change of bed/mattress may help, a more comfortable environment to sleep in

This section should be used in conjunction with your increased activity levels, as well as your day to day activities.  It is a key technique in pain management.

The term pacing, involves making sure that any activities (either exercise, physical activities or even just housework) are done at just the right levels to be of benefit to you, but at the same time not cause a flare up. Many people are guilty of “over-doing it” when they have a “good day”, which often leads to an increase in pain and subsequent reduction in activity levels. Pacing in this example would be not over doing it, but instead breaking an activity down into small sections to ensure the increase in pain isn’t experienced, but the end result is the completion of the activity.

The following breakdown of the technique looks and sounds complicated, but once you have done it a couple of times it becomes second nature.

• Pick the activity – Walking the dog, housework, a working day, socializing with family.
• Establish your baseline – This is the amount of that activity you can do before the pain increases. For example 10 minutes walking, sitting at a table for 20 minutes, hoovering 2 rooms etc.
• Set Goals – State to yourself how you want to increase each of those activities (ie manage 30 minutes walking, or hoover the whole house in 1 day). The goals should be realistic, as not managing to achieve them will reduce your confidence and motivation to change.
• Set a Plan of Action – State how you can achieve your goals without overstepping your baseline. (More regular 10 minute walks and then gradually increase the time, hoovering 1 room at a time with a break after each to allow rest).
• Don’t stray from the plan – don’t be tempted to “over-do it” on a good day.
• Keep checking the baseline to see if you are improving.

It isn’t an easy skill or technique to master but it does work for a lot of people, and if you stick with it, then it can change some of those feelings of “I cant do this/that because of my pain” to “I can do those things but I might need to do them a little differently. Which then has a positive impact on our motivation to change.

Mindfulness meditation can be used as a tool to create more awareness of the sensation of pain itself, without judgement or resistance, and the thoughts and emotions we often project upon it. It has shown to be successful in reducing pain in those whose pain has become persistent.

When we continually enforce a series of negativity on our pain, it only makes the pain worse and has the potential to prompt other difficulties including depression and anxiety.

When we become more aware of what we are actually experiencing through mindfulness, without the overlay of our judgement, our perceptions of pain can reduce.

The mechanism of pain relief during mindful meditation is still being explored but many studies show that this may be a result of reduction in activity in or to the areas of the brain responsible for interpreting and evaluating pain.

Off-the-shelf painkillers, such as paracetamol, to reduce your pain is safe and recommended if this means you can be more active.

It is important to take painkillers at the recommended dose and to take them regularly, normally every 4 to 6 hours. This may be a way to simply manage flare ups or to allow you to exercise or complete an activity.

It is also recommended not to wait until your pain is severe to start taking painkillers as this can reduce the effectiveness.

Should you have any concerns about taking painkillers or if you have already completed a 2 week course of painkillers and they have not worked, seek help from your local GP or pharmacist.