Understanding Chronic Pain
Chronic pain is an unpleasant sensory and emotional experience that occurs in response to actual or perceived tissue damage (International Association for the Study of Pain, 2017). Since pain is a unique experience, it is often quantified based on personal descriptions. For example, using the verbal numerical rating scale (VNRS) with 10/10 being the worst pain imaginable and 0/10 being no pain (Williamson & Hoggart, 2005). Additionally, the character of chronic pain can be described as sharp, dull, aching, or burning (Merskey & Bogduk, 1994).
How the Brain Responds to Chronic Pain
When we talk about the sudden onset of pain, or acute pain, our nerve cells responsible for detecting damage, called nociceptors, are triggered and send signals from the area of damage to the spinal cord and into the brain (Fields, 1987). The information is then processed by cells called neurons and glial cells within the grey matter (Millan, 1999). From there, the white matter carries the information as electrical impulses. The information travels from the spinal cord to the prefrontal cortex in the brain, specifically the medial prefrontal cortex, the dorsolateral prefrontal cortex, and the orbitofrontal cortex (Apkarian et al., 2005). Here, the brain decides what to do with the painful stimulus and how to respond.
As pain can have significant consequences, we have a network of interconnected cells called our salience network, which helps us decide what we need to pay attention to (Seeley et al., 2007). Now that we have the stimulus and the attention of our brain, it will then respond accordingly, for example, by activating your motor pathways to off-load your leg after you sprain your ankle (Basbaum & Jessell, 2000).
However, we also have modulators to help us cope with painful experiences, and the modulation network will be activated and secrete chemicals such as endorphins to dampen the sensation in acute painful settings (Millan, 2002). Therefore, all these processes work together to deliver your experience of pain, the intensity at which you feel pain, and the actions that follow.
Variability in Chronic Pain
These systems have large levels of variance from person to person, which is why one pain experience could be different from another, even if two individuals have the exact same injury (Melzack, 1999). This is also why some might be able to cope better with painful stimuli than others. It also explains why some individuals may experience acute pain as a protective and beneficial mechanism to assist with healing an injury, while others may go on to experience chronic pain that hinders normal functioning and quality of life (Tracey & Mantyh, 2007). This variability is also why chronic pain can be difficult to treat, as there are factors that may increase or decrease our sensitivity to pain (Mayer & Bushnell, 2009).
Currently, there is no way to pre-determine who will positively respond to more movement-based therapies such as weight training, yoga, hydrotherapy, or Pilates. But as we know, exercise and movement can have profound and positive secondary benefits in addition to pain management, which is always an important point of discussion (Geneen et al., 2017).
Pilates for Chronic Pain
Pilates is a commonly used exercise methodology for managing chronic pain. It focuses on controlled movements, improving strength, flexibility, and posture (Wells et al., 2014).
By emphasising precise, controlled movements, it helps with improving neuromuscular pathways, helping the brain and body communicate more effectively. This retrains the nervous system, assisting with the reduction in pain sensitivity and improving movement efficiency (Lange et al., 2000).
Regular practice can improve mood, increase strength, flexibility, and balance, and assist with the management of pain. Additionally, Pilates enhances body awareness, helping individuals to move more freely, building confidence with movement variability (Johnson et al., 2007).
Yoga for Chronic Pain
Yoga is another valuable practice for managing chronic pain. It also focuses on the connection between mind and body, promoting a state of relaxation (Sherman et al., 2005). Yoga techniques engage the parasympathetic nervous system, encouraging the body to enter the “rest and digest” state where breathing is slower, the heart rate is slower, and chemical changes in the brain encourage relaxation (Streeter et al., 2012).
Regular yoga practice can help address movement-related aspects of chronic pain, such as touch sensitivity, tissue tolerance, and the feeling of tightness and stiffness. It also helps improve mood, autonomy, and self-efficacy in managing chronic pain (Busch et al., 2012).
Exercise for Pain and Disability
Chronic pain and disability can significantly impact your quality of life. An Accredited Exercise Physiologist (AEP) can play a crucial role in managing various conditions through personalised exercise programs (Williams et al., 2012).
AEPs work with all disabilities and will start with a comprehensive assessment to understand the individual, limitations and goals and from there, tailor a unique and effective exercise intervention. AEPs help improve strength, flexibility, balance, fitness and mobility, to enhance daily function. Regular monitoring and adjustments ensure the exercise program remains effective as your condition evolves, helping you achieve lasting improvements (Simmonds et al., 1996).
With the support of an AEP, there will be focus on regaining independence, improving quality of life, and managing chronic pain more effectively (Hurley et al., 2018).
Key Takeaway
The important takeaway message from this article is that pain is complex and involves multiple systems and processes that are significantly different from person to person, meaning that everyone’s pain experience is unique depending on past experiences, levels of understanding, contextual factors, and an individual’s physiology. Although this can make chronic pain multi-faceted and complex, it also means that interventions can be broad and varied and will depend on the individual (Buchbinder et al., 2018).
Additional Resources
For those working with chronic pain patients or experiencing chronic pain, we recommend visiting the NOI group and Flippin’ Pain UK websites. They offer access to free resources, educational material, and ways to upskill in this area.
Call to Action
For personalised advice, ensure that exercise physiologists are part of your multidisciplinary team to help you treat and manage your chronic pain effectively. Book your appointment today and take control of your chronic pain.
References
Apkarian, A. V., Bushnell, M. C., Treede, R. D., & Zubieta, J. K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. European
Basbaum, A. I., & Jessell, T. M. (2000). The perception of pain. In E. R. Kandel, J. H. Schwartz, & T. M. Jessell (Eds.), Principles of Neural Science (4th ed., pp. 472-491). McGraw-Hill
Buchbinder, R., van Tulder, M., Öberg, B., Costa, L. M., Woolf, A., Schoene, M., … & Croft, P. (2018). Low back pain: a call for action. The Lancet, 391(10137), 2384-2388. https://doi.org/10.1016/S0140-6736(18)30488-4
Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., & Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing—an experimental study. Pain Medicine, 13(2), 215-228. https://doi.org/10.1111/j.1526-4637.2011.01243.x
Daly, R. M., Bass, S. L., & Cameron-Smith, D. (2005). Exercise as an anabolic stimulus for bone and muscle. Current Opinion in Anesthesiology, 18(5), 411-418. https://doi.org/10.1097/01.aco.0000179232.55927.39
Fields, H. L. (1987). Pain. McGraw-Hill.
Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD011279.pub2
Hurley, M. V., Walsh, N. E., Mitchell, H., Nicholas, J., Patel, A., & Williamson, E. (2018). Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care & Research, 70(1), 34-42. https://doi.org/10.1002/acr.23237
International Association for the Study of Pain. (2017). IASP terminology. Retrieved from https://www.iasp-pain.org/resources/terminology
Johnson, E. G., Larsen, A., Ozawa, H., Wilson, C. A., & Kennedy, K. L. (2007). The effects of Pilates-based exercise on dynamic balance in healthy adults. Journal of Bodywork and Movement Therapies, 11(3), 238-242. https://doi.org/10.1016/j.jbmt.2006.08.008
Lange, C., Unnithan, V. B., & Larkham, M. A. (2000). Maximizing the benefits of Pilates-inspired exercise for learning functional motor skills. Journal of Bodywork and Movement Therapies, 4(2), 99-108. https://doi.org/10.1016/S1360-8592(00)80018-0
Mayer, D. J., & Bushnell, M. C. (Eds.). (2009). The science of pain. Academic Press.
Melzack, R. (1999). From the gate to the neuromatrix. Pain, 82, S121-S126. https://doi.org/10.1016/S0304-3959(99)00145-1
Merskey, H., & Bogduk, N. (1994). Classification of chronic pain (2nd ed.). IASP Press.
Millan, M. J. (1999). The induction of pain: an integrative review. Progress in Neurobiology, 57(1), 1-164. https://doi.org/10.1016/S0301-0082(98)00048-3
Millan, M. J. (2002). Descending control of pain. Progress in Neurobiology, 66(6), 355-474. https://doi.org/10.1016/S0301-0082(02)00009-6
Nicholas, M. K., Molloy, A. R., Tonkin, L. E., Beeston, L. R., & Beeston, L. A. (2011). Manage your pain. ABC Books.
Seeley, W. W., Menon, V., Schatzberg, A. F., Keller, J., Glover, G. H., Kenna, H., … & Greicius, M. D. (2007). Dissociable intrinsic connectivity networks for salience processing and executive control. Journal of Neuroscience, 27(9), 2349-2356. https://doi.org/10.1523/JNEUROSCI.5587-06.2007
Sherman, K. J., Cherkin, D. C., Erro, J. H., Miglioretti, D. L., & Deyo, R. A. (2005). Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Annals of Internal Medicine, 143(12), 849-856. https://doi.org/10.7326/0003-4819-143-12-200512200-00003
Simmonds, M. J., Kumar, S., & Lechelt, E. (1996). Psychosocial factors in disabling low back pain: causes or consequences? Disability and Rehabilitation, 18(4), 161-168. https://doi.org/10.3109/09638289609166022
Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., Yakhkind, A., … & Jensen, J. E. (2012). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. Journal of Alternative and Complementary Medicine, 16(11), 1145-1152. https://doi.org/10.1089/acm.2010.0007
Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377-391. https://doi.org/10.1016/j.neuron.2007.07.012
Wells, C., Kolt, G. S., Marshall, P., Hill, B., & Bialocerkowski, A. (2014). Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews. BMC Medical Research Methodology, 14(1), 7. https://doi.org/10.1186/1471-2288-14-7
Williams, M. A., Haskell, W. L., Ades, P. A., Amsterdam, E. A., Bittner, V., Franklin, B. A., … & Stewart, K. J. (2012). Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation, 116(5), 572-584. https://doi.org/10.1161/CIRCULATIONAHA.107.185214
Williamson, A., & Hoggart, B. (2005). Pain: a review of three commonly used pain rating scales. Journal of Clinical Nursing, 14(7), 798-804. https://doi.org/10.1111/j.1365-2702.2005.01121.x