Exercise Hyped as Universal Solution to Chronic Pain

Is exercise the new snake oil? or just a dirty word? | HealthSkills Blog – by Bronnie Thompson – Aug 2020

This is a great article explaining that while exercise is generally “good for you”, it does very little to relieve pain and disability. The studies that supposedly prove this are problematic and cited more than they deserve to be.

Exercise can do all these wonderful things – help you lose weight, reduce heart disease, moderate insulin and blood glucose levels, improve your mental health, and yes! reduce pain and disability when you’re sore. (check this list out)

The claims sound suspiciously similar to the claims made by old snake oil merchants.

Qualitative researchers have often investigated how people with pain view exercise:

• “I get the comments that “It is not dangerous” and that “you are not going to be worse.”  I do not believe it is dangerous … but actually it happens that I become worse after .… I know that the pain will increase.

This is just how I feel: most exercise isn’t “dangerous”, just painful both during and afterward and even worse the morning after.

• And they … talk to me about pain that is not like my pain.” 

Most doctors don’t really have a clue about persistent pain. They know about acute pain, but it’s impossible to imagine how pain changes over time as the nervous system adapts to the constant “noise” of pain signals.

Doctors talk authoritatively to their pain patients but have not earned the authority to tell us, instead of listening to us, what treatment works for our malady.

• “any minimal physical activity, standing still in one spot, is torture”

I just experienced this a few days ago when walking extremely slowly with a friend who has been debilitated by chronic kidney disease. It felt like I had to wait after each step.

Without the relief of regular motion, that waiting was putting steady pressure into my right hip and provoking more and more deep pain. It just kept getting worse, worse than it’s ever been, until I finally had to leave my friend on the sidewalk to rush back to the house, take a pain pill, and lie down.

I’m so grateful that I can still get opioids for episodes like this: inexplicable and extreme pain from unknown causes.

“I don’t have any desire to exercise. A lack of motivation, even apprehension” 

I certainly understand this apprehension; we risk pain with everything we do, not just exercising. I expect a doctor would view this as a “bad attitude” and my fears about aggravating my pain could be derided as mere “catastrophizing”, but pain patients have to struggle with this all the time.

• It’s not that I don’t want to it is just that I cannot. I am unable to

I’ve often wondered what we mean when we say “I can’t do this because it hurts too much”.  If we were being chased by a tiger, of course, we could do that and much more, but without such a powerful motivator, it seems impossible to surmount the pain.

So, at what point should we say we cannot?

For me, there’s a limit to the pain I’m willing to endure and a limit to the amount of energy I can devote. It’s always a tradeoff and never predictable.

Sometimes I can practically run up the slope to the car here, other times I have to stop once or twice to rest and allow the horrific muscle burn to subside. There seems to be no rhyme or reason to this great variation over days and even hours.

• “Sometimes I try to exercise and then I’m in pain, looking back had I known it would hurt I would probably not have done it”

I try to be aware of how I’m using my body and do my best to maintain proper posture and avoid repetitive movements, but sometimes, especially if I’m having fun or if others are involved, I forget, or I decide the tradeoff is worth the experience I’m having.

Sometimes I feel the next day’s agony was “worth it”, sometimes not. Again, it’s totally unpredictable.

At the same time as these negative views, many participants in qualitative studies report that they use “movement” as a key strategy for their daily management.

This is certainly true for me and I’ve been slacking terribly lately. I used to set a repeating timer to get up and walk up the stairs every half hour or hour, but now I’m ignoring the notifications.

I’m pretty sure it’s the corona-stress that’s getting to me, smothering my energy, dialing up my pain. I was doing great the first couple of months, fine for the next couple of months, but now I’m worn out.

With the burden of both physical disability (pain, weakness, lack of coordination) and verging on mental disability (anxiety, depression), I am NOT resilient. I don’t think anyone can expect us to be resilient when we use so much energy managing our chronic illness and pain; there’s just nothing left over.

Now one very important point about exercise, and one that’s rarely mentioned, is how little exercise actually reduces pain – and disability.

A systematic review of systematic reviews from the Cochrane collaboration found that most studies included people with mild-to-moderate pain (less than 30/100 on a VAS) but the results showed pain reduction of around 10mm on a 0 – 100mm scale. In terms of physical function, significant improvements were identified but these were small to moderate in size.

Most studies are quite small, which can lead to over-estimating the benefits, while biases associated with randomisation, blinding and attrition rate/drop-outs, adherence and adverse effects.

Before anyone starts getting crabby about this blog post, here are my key points (and why I’ve taken this topic on!):

• Over-stating the effects of exercise won’t win you friends.
• Exercise and physical activity can be done in a myriad of wonderful ways,
• The reasons for doing exercise are enormously variable.
• Without some carryover into daily life (unless the exercise is intrinsically pleasurable), exercise is a waste of time.

This is a wonderful and thoroughly researched article and definitely worth reading in full: Is exercise the new snake oil? or just a dirty word? | HealthSkills Blog