Dismissing Chronic Pain With Exercise
There is a community that I often refer to as the chronic pain or invisible illness community. A reoccurring complaint I see in support groups and other forums is doctors, strangers, loved ones, etc. telling people in the chronic pain community that all they need to do is try yoga, exercise more, lose more weight, etc. “If you exercise, you wouldn’t be in pain. If you lose weight, that pain would go away.” I do believe that this is said (for the most part) with good intentions but oftentimes, there is a lack of knowledge behind the statement or a lack of resources, empathy, support, and follow-up.
Kyle Vader, MScPT, Rupa Patel, MD, Tom Doulas, BScPT, and Jordan Miller, PhD conducted a study focused on a diverse group of individuals with chronic pain. The participants were interviewed for 3 months and provided input regarding exercising with chronic pain and what they would like from doctors when exercise is suggested as a method of helping with chronic pain.
Participants in this study expressed how difficult it is to find the motivation to exercise because of how much the body can change due to illnesses. What someone with chronic pain could do 2 years or 2 months ago, they may not be able to do now.
The study and participants suggested multiple ways to help people with chronic pain exercise.
· Self-Talk: Learn the role of self-talk and how to use this as motivation to exercise. Self-talk is a great way to help people figure out what they can and can’t do at that time. Just because someone can’t lift a certain weight now, doesn’t mean they won’t be able to in the future. By learning to self-talk people are able to find the motivation to do what they can in the present. The saying goes, ‘when one door closes, another opens.’
· Goals: Hand in hand with self-talk is having goals. To set goals and achieve them, motivation is needed. Self-talk is a great way to get that motivation which is how the tools all start to tie in together.
· Setting up for Success: Being consistent is important. There is a higher chance of quitting if there is no consistency. One participant tried to commit to yoga every other day but noticed that his pain was worse or not improving, so he started to make excuses and stopped showing up. He started yoga again but instead went every day. He prioritized exercise, which is a huge part of setting yourself up for success. When he began going every day is when he started to see improvements in his pain and mobility
· Modify the intensity of the activity: The sane participant also spoke on the importance of modifying the intensity of the activity. If you are having a bad pain day, focus on low-intensity exercise. If you need to walk away and rest, do so. Then try to go back later that day and exercise again.
· Different types of exercise: Discuss with doctors or trainers the different kinds of exercise, especially when dealing with health issues. The treadmill may not be the best option even though it was a go-to in the past. Participants started with low-impact physical activities such as yoga, water aerobics, swimming, or a brisk walk. Once the body could handle the low-impact activity then each person would try to see if they could push themselves a little further whether that meant walking faster, walking a longer distance, swimming more laps, or trying a different activity.
Managing pain during and after physical activities
This is a concern for many with chronic pain. Some participants relied on pain medication and took medication before exercising. Others relied on heating pads or ice packs. The heat or ice was vital for them to be able to continue with their activities. There is also the importance of having a positive mindset and thinking in the moment. A negative mindset can cause pain, cause people not to do certain activities, and thinking too far ahead can stop people from reaching goals. The brain is strong. People can talk/think themselves into more pain, talk themselves out of doing certain things, and convince themselves that they can’t do certain things. Having a positive mindset or at least trying to have one while going into this is essential.
Finally, let’s dig in on how it would be helpful for doctors to actively listen and provide tailored advice when suggesting exercise.
One participant said,
“I think the number one thing is listening to where they’re at and asking them where they think is the next step for them.” (INT-1; woman who self-reported having cervicogenic headaches)
The Invisible Illness community wants to be heard. Instead of a blanket statement about exercise, it would be beneficial for doctors to listen to where people are physically and mentally. They are not fitness trainers and cannot set up a workout plan but they know their patient’s health and bodies. Sometimes the advice given regarding exercise is not realistic. Some participants felt that doctors giving patients options for low-impact activities depending on where a patient currently is mentally and physically, would be useful. Providing them with different options for good days and bad days that allow them to choose what they want to do instead of feeling like it is being prescribed to them is better for both parties.
Following up with patients about exercising and holding them accountable while being supportive of their struggles was also a focus point in this study. If doctors are actively listening, helping to provide options for their patients, and then following up in a supportive manner, the view of exercise among the chronic illness community may change. More people may find the motivation to try low-impact activities and report back on how it is helping or not helping. It may even help doctors figure out what activities to suggest to patients with the same conditions.
Reference: Vader, K., Patel, R., Doulas, T., & Miller, J. (2020). Promoting Participation in Physical Activity and Exercise Among People Living with Chronic Pain: A Qualitative Study of Strategies Used by People with Pain and Their Recommendations for Health Care Providers. Pain medicine (Malden, Mass.), 21(3), 625–635. https://doi.org/10.1093/pm/pnz246
