Walking Away from the Pain: The Importance of Paced Physical Activity in the Management of Chronic Pain

Dr. Allegra Nevins, PsyD
August 8, 2024

What is Chronic Pain?

Chronic pain, in contrast to acute pain, is a condition wherein a person experiences significant pain almost daily, with or without a known cause, for longer than three months; it persists beyond expected healing time and despite treatment. In a recent study conducted by the CDC, it was found that nearly 51.6 million Americans struggled with chronic pain in 2021—that’s about one in five adult Americans [1]. Chronic pain can dramatically impact quality of life and lead to loss of work productivity and inability to engage in daily activities; it is highly associated with work absenteeism as well as the development of Alzheimer’s disease/dementia, suicidal thinking, substance abuse, and depression [1]. In the past, chronic pain was primarily managed through pharmaceuticals, which contributed to the Opioid Epidemic that our country is currently facing; though there is little evidence that long-term usage of opiates for non-cancer chronic pain is beneficial [2].

What is the Chronic Pain Cycle?

Many people with chronic pain fear that activity/exercise will increase pain or cause physical damage/injury. Because of this fear, many individuals avoid engaging in physical activity which can lead to physical deconditioning (i.e., decreased strength, less stamina, weight gain). Decreased physical activity and having to cope with constant pain may also lead someone to have negative thoughts/feelings, which can actually influence a number of pain-related issues in themselves, including the “intensity of pain, anxiety and depression, physical disability, activity limitations, and catastrophizing” [2]. So while it may seem to make sense to not engage in physical activity to someone who is experiencing chronic pain, it’s not helpful! It can lead to more negative consequences over time.

What are the costs of inactivity? [3]

  • More pain
  • Poor physical fitness
  • Less time with family/friends
  • Irritability and/or depressed mood
  • Lower self-esteem
  • Increased strain on relationships
  • Worse quality of life

What factors impact the chronic pain experience? [3]

Chronic pain is influenced by biological factors (pain, medical issues), psychological factors (emotions, attention, thoughts), and social factors (relationships, jobs, hobbies). Some of these factors may increase pain while others may decrease pain; you have the power to decide how to manage them!

Factors that may increase pain

  • Physical: Illness, new injury, muscle tension
  • Thoughts: Expecting the worst, focusing on the pain
  • Emotions: Depression, anger, worry, stress, anxiety
  • Behaviors: Too little (or too much) activity, lack of involvement in hobbies
  • Social: Isolation, lack of (or too much) support from others

Factors that may decrease pain

  • Physical: Seeking medical treatment, using relaxation exercises
  • Thoughts: Balancing positive/negative thinking distraction techniques
  • Emotions: Appropriate emotional expression, seeking social support engaging in pleasant activities, using relaxation techniques
  • Behaviors: Pacing yourself, doing more of what you enjoy
  • Social: Spending time with family/friends, volunteering/staying involved in the community

Can activity really help with chronic pain?

It may seem unnatural that movement will make pain better, and this may be difficult to accept, but it is the foundation for building a better body and breaking the Chronic Pain Cycle! Physical activity can lead to increased endurance and strength, cause muscles to return to normal size, and help you have less pain when you move [4]. Just be sure to pace yourself and consult with a physician prior to engaging in new physical activities!

What is Chronic Pain?

Chronic pain, in contrast to acute pain, is a condition wherein a person experiences significant pain almost daily, with or without a known cause, for longer than three months; it persists beyond expected healing time and despite treatment. In a recent study conducted by the CDC, it was found that nearly 51.6 million Americans struggled with chronic pain in 2021—that’s about one in five adult Americans [1]. Chronic pain can dramatically impact quality of life and lead to loss of work productivity and inability to engage in daily activities; it is highly associated with work absenteeism as well as the development of Alzheimer’s disease/dementia, suicidal thinking, substance abuse, and depression [1]. In the past, chronic pain was primarily managed through pharmaceuticals, which contributed to the Opioid Epidemic that our country is currently facing; though there is little evidence that long-term usage of opiates for non-cancer chronic pain is beneficial [2].

What is the Chronic Pain Cycle?

Many people with chronic pain fear that activity/exercise will increase pain or cause physical damage/injury. Because of this fear, many individuals avoid engaging in physical activity which can lead to physical deconditioning (i.e., decreased strength, less stamina, weight gain). Decreased physical activity and having to cope with constant pain may also lead someone to have negative thoughts/feelings, which can actually influence a number of pain-related issues in themselves, including the “intensity of pain, anxiety and depression, physical disability, activity limitations, and catastrophizing” [2]. So while it may seem to make sense to not engage in physical activity to someone who is experiencing chronic pain, it’s not helpful! It can lead to more negative consequences over time.

What are the costs of inactivity? [3]

  • More pain
  • Poor physical fitness
  • Less time with family/friends
  • Irritability and/or depressed mood
  • Lower self-esteem
  • Increased strain on relationships
  • Worse quality of life

What factors impact the chronic pain experience? [3]

Chronic pain is influenced by biological factors (pain, medical issues), psychological factors (emotions, attention, thoughts), and social factors (relationships, jobs, hobbies). Some of these factors may increase pain while others may decrease pain; you have the power to decide how to manage them!

Factors that may increase pain

  • Physical: Illness, new injury, muscle tension
  • Thoughts: Expecting the worst, focusing on the pain
  • Emotions: Depression, anger, worry, stress, anxiety
  • Behaviors: Too little (or too much) activity, lack of involvement in hobbies
  • Social: Isolation, lack of (or too much) support from others

Factors that may decrease pain

  • Physical: Seeking medical treatment, using relaxation exercises
  • Thoughts: Balancing positive/negative thinking distraction techniques
  • Emotions: Appropriate emotional expression, seeking social support engaging in pleasant activities, using relaxation techniques
  • Behaviors: Pacing yourself, doing more of what you enjoy
  • Social: Spending time with family/friends, volunteering/staying involved in the community

Can activity really help with chronic pain?

It may seem unnatural that movement will make pain better, and this may be difficult to accept, but it is the foundation for building a better body and breaking the Chronic Pain Cycle! Physical activity can lead to increased endurance and strength, cause muscles to return to normal size, and help you have less pain when you move [4]. Just be sure to pace yourself and consult with a physician prior to engaging in new physical activities!

References

  1. Rikard S. M., Strahan, A. E., Schmit, K. M. & Guy, G. P. Chronic pain among adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep 2023;72:379-385.
  2. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Phillips JK, Ford MA, Bonnie RJ, editors. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington (DC): National Academies Press (US); 2017 Jul 13. 2, Pain Management and the Intersection of Pain and Opioid Use Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK458655/
  3. Beehler, G. P., Conrad, M. L., Dimoff, J., Haslam, A., & Murphy, J. (2021). Brief Cognitive Behavioral Therapy for Chronic Pain: Patient Guidebook. Washington, DC: U.S. Department of Veterans Affairs.
  4. Murphy, J.L., McKellar, J.D., Raffa, S.D., Clark, M.E., Kerns, R.D., & Karlin, B.E. Cognitive behavioral therapy for chronic pain among veterans: Therapist manual. Washington, DC: U.S. Department of Veterans Affairs.

About the Author

Dr. Allegra Nevins, PsyD