Chronic pain can be a debilitating ailment to live with and can result in other secondary conditions such as depression, sleep disorders, and more. With medication being one of the most prescribed treatments, can we offer more than just drugs to increase a person’s quality of life?
This article will look at what other adjunct treatments we can use to relieve pain and increase one’s quality of life.
What is Chronic Pain?
Neuropathic pain is categorised as “pain directly caused by a lesion or disease affecting the somatosensory system either at peripheral or central level” (3). The common reason for neuropathic pain includes diabetic peripheral neuropathy, spinal cord injuries, cancer, and sciatic nerve injury (2,3,4,5,7). This most often leads to chronic pain which is a common and complex condition characterised by persistent pain experienced on most days of the week and lasts beyond the normal healing time after injury or illness, generally 3 to 6 months (10).
How can we treat Chronic Pain?
Chronic pain can be treated alone or in a combination with using pharmacologic and non-pharmacologic approaches, such as physical activity (aerobic conditioning, muscle strengthening, flexibility training, and movement therapies) (6). Not only do physical prescriptions help with the reduction of pain, its beneficial to overall health disease risk, and the progression of chronic illnesses such as cardiovascular disease, type 2 diabetes, and obesity.
Studies have recorded that exercise can be fundamental in the rehabilitation process for people experiencing an array of chronic musculoskeletal ailments, such as fibromyalgia, chronic back/neck pain muscle pain etc (9). These studies have shown that exercise not only reduces pain perception but can positively impact on a person’s mental health increasing mood and reducing stress and other disorders like depression, which is frequently linked to chronic pain conditions (1). Furthermore, research has found that exercise can effectively ease Neuropathic pain, as discussed earlier, which is difficult to treat clinically (2).
When prescribing exercise for chronic pain conditions we need to consider the appropriate parameters such as frequency, duration, and intensity. These parameters will depend on several factors including the severity of the injury, mobility of a person, and mental/emotional state.
Although resting for short periods can alleviate pain, too much rest may increase pain and put people at greater risk of injury when they again attempt movement. Research has shown that regular exercise can diminish pain in the long term by improving muscle tone, strength, and flexibility. Exercise can also cause a release of endorphins, which are the body's natural painkillers.
Some exercises are easier for certain chronic pain sufferers to perform than others but starting off with low-intensity prescriptions focusing on mobility, balance and functional strength is a great way to gauge where your clients are at in terms of their pain threshold and tolerance. From these prescriptions, you can regress or progress where needed. Start with non-loading prescriptions using body-weighted movement patterns or tools like stick mobility. Then gradually build on these prescriptions by adding strength bands and/or light weights to further enhance the functional strength of your client. This can be a trial-and-error process so make sure you are monitoring your client and keeping check of their pain scores.
Adjunct therapies
Adjunct therapies are therapies that are another treatment used together with the primary treatment to assist in offering a better outcome or quality of life.
For chronic pain sufferers, we can use several different therapies to alleviate pain which can assist in helping people attend an exercise program. These therapies include;
Cryotherapy. Whole Body Cryotherapy (WBC) is used to help numb nerve pain-reducing nerve transmission velocity in pain fibers, which may be a way that cryotherapy induces an analgesic effect and pain relief (11). Chronic inflammation can contribute to constant pain by chemical and mechanical stimulation of pain receptors and free nerve endings (12), which commonly occurs in autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, and multiple sclerosis, this is also witnessed in persons with musculoskeletal ailments such as lower back pain, shoulder pain and pain after surgery of the hip, knee, and shoulder replacement/s. Thus, there is a strong interest in using cryotherapy to reduce this inflammation in these chronic pain syndromes and to reduce the subsequent pain associated.
Infrared Therapy. Infrared saunas have also been shown to induce the release of endorphins (yes, not just exercise), an important pain reliever. Both actions can be beneficial in reducing chronic pain, muscle spasms, and joint stiffness due to conditions such as fibromyalgia, arthritis, and chronic fatigue syndrome. A recent Japanese study published in the journal, Internal Medicine, showed that chronic pain patients experienced a significant reduction in pain levels (nearly 70%) after the first session of infrared sauna therapy. Pain scores also decreased significantly and remained low throughout the observation period. Researchers concluded that infrared heat therapy is effective for chronic pain treatment and is another excellent therapy to assist in getting chronic pain sufferers back into exercise (13) Finally, a 2003 study conducted by the Department of Dermatology and Institute of Medical Research showed that the use of near-infrared heat therapy helped the production of white blood cells to alleviate inflammation and reduce swelling, two key factors in easing bodily pain and allowing a person to partake in more physical activities (14).
Dynamic Compression Therapy. Dynamic compression devices provide a therapeutic, controlled external compression or pressure cycle to a limb. Compressed air intermittently inflates a specially designed garment to assist in dispersing inflammation, release muscle tension, drain the lymphatic system and assist in reducing pain and creating better limb mobility. Research has found Dynamic compression helps people recover faster and allows for better performance and mobility (15. )
Anti-Gravity Therapy. Anti-gravity therapy is a safe intervention that helps improve functional outcomes (16). Anti-gravity treadmills use air pressure to help reduce the weight of the user. By reducing the weight there is less impact on the body, less pain associated, and better mobility allowing the user to partake in an exercise that would be impossible without this type of therapy.
(1) Bement MKH & Sluka KA (2016). Exercise-induced analgesia: an evidence-based review. In Mechanisms and Management of Pain for the Physical Therapist, 2nd edn, ed. KA Sluka, Ch. 10. pp. 177– 201. Wolters Kuwer, IASP Press, Seattle
(2) Bhatnagar S, Mishra S, Roshni S, Gogia V, Khanna S. Neuropathic pain in cancer patients-prevalence and management in a tertiary care anesthesia-run referral clinic based in urban India. J Palliat Med. 2010;13(7):819–824
(3) Chen, Y. M., & Wang, X. Q. (2020). Bibliometric Analysis of Exercise and Neuropathic Pain Research. Journal of pain research, 13, 1533–1545
(4) Colberg SR, Vinik AI. Exercising with peripheral or autonomic neuropathy: what health care providers and diabetic patients need to know. Physician Sportsmed. 2014;42(1):15–23
(5) Grond S, Radbruch L, Meuser T, Sabatowski R, Loick G, Lehmann KA. Assessment and treatment of neuropathic cancer pain following WHO guidelines. Pain. 1999;79(1):15–20
(6) Kirsten R. Ambrose, Yvonne M. Golightly, Physical exercise as non-pharmacological treatment of chronic pain: Why and when,Best Practice & Research Clinical Rheumatology, Volume 29, Issue 1, 2015, 120-130
(7) Whitehead RA, Lam NL, Sun MS, et al. Chronic sciatic neuropathy in rat reduces voluntary wheel-running activity with concurrent chronic mechanical allodynia. Anesth Analg. 2017;124(1):346–355
(8) Haanpaa M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011;152(1):14–27
(9) Norrbrink C, Lindberg T, Wahman K, Bjerkefors A. Effects of an exercise program on musculoskeletal and neuropathic pain after spinal cord injury results from a seated double-poling ergometer study. Spinal Cord. 2012;50(6):457–461
(10) Chronic Pain in Australia, 7 May 2020, https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/contents/summary
(11) Chanliongo PM. Cold (cryo) therapy. In: Lennard TA, Walkowski S, Singla AK, Vivian DG, editors. Pain procedures in clinical practice. Philadelphia: Elsevier; 2011. p. 555–8
(12) Behrens BJ, Beinert H. Physical agents: theory and practice. 3rd ed. Philadelphia: F. A. Davis Company; 2014.
(13) Internal Medicine (Tokyo) Aug 15, 2008, by Matsushita K, Masuda A, Tei C. The First Department of Internal Medicine, Kagoshima University Hospital, Kagoshima, Japan.
(14) Lidija Kandolf-Sekulovic, Milena Kataranovski, Milos D. Pavlovic. Immunomodulatory Effects of Low-Intensity Near-Infrared Laser Irradiation on Contact Hypersensitivity Reaction. Photodermatol Photoimmunol Photomed 2003; 19: pp 203–212, Blackwell Munksgaard.
(15) Sands WA, McNeal JR, Murray SR, Stone MH. Dynamic Compression Enhances Pressure-to-Pain Threshold in Elite Athlete Recovery: Exploratory Study. J Strength Cond Res. 2015 May;29(5)
(16) Bugbee WD, Pulido PA, Goldberg T, D'Lima DD. Use of an Anti-Gravity Treadmill for Early Postoperative Rehabilitation After Total Knee Replacement: A Pilot Study to Determine Safety and Feasibility. Am J Orthop (Belle Mead NJ). 2016 May-Jun;45(4).
