Exercise and Pain, Like Sunshine and Sunshine?

8/15/2014 in Blog Categories, News, Treatment

Pain.  Just writing it conjures up unpleasant memories of illness and injuries.  And whether we like it or not, we all experience pain.  In many cases, pain is present for a very good reason:  it is the body’s way to tell the brain to stop, that something bad happened or is about to happen.  Hence, it hurts when we touch a hot burner on the stove so we yank our hand back.  A sprained ankle hurts when we put weight on it so we stay off it (or at least limp).  Pain is, at least in part, a protective mechanism. 

Pain can also be debilitating.  When it is not nociceptive (i.e., when it is not caused by a pain-inducing stimulus as in the examples above), pain immobilizes us even though it often does not serve a protective function.  This frequently has deleterious consequences for our health.  We become sedentary.  We gain weight.  We become depressed.  We lose confidence. 

When it comes to pain, we typically are dealing with two related but different phenomena:  threshold and tolerance.  Threshold refers to the point at which a person feels pain.  Different persons have different pain thresholds.  Also, it appears that a person’s pain threshold appears not to change over time (though chronic narcotic usage can lower a person’s pain threshold).  Tolerance refers to how much pain a person can handle.  Common tolerance measurements would include things such as how much pain can a person tolerate before they seek medication, or how much pain can a person tolerate before they seek to remove the painful stimuli.

We know that pain which serves no nociceptive purpose often immobilizes us.  But what if there was a way to make the pain more tolerable, to increase our ability to handle the pain and be more active?  According to research (subscription required) reported on in the New York Times, there is something that can increase our tolerance of pain:  exercise.  Not a two billion dollar drug or expensive surgery, just good old-fashioned exercise.  In the study, one group of healthy but sedentary individuals was placed on an exercise plan while the control group of healthy but sedentary individuals was not.  The two groups were then subject to testing throughout the study that measured both pain threshold and tolerance.  As Gretchen Reynolds notes, “volunteers in the exercise group displayed substantially greater ability to withstand pain.”  Interestingly, the study found that the participants’ pain threshold did not change, only their tolerance did.  As Matthew Jones, one of the researchers stated, “to me…the participants who exercised had become more stoical and perhaps did not find the pain as threatening after exercising, even though it still hurts as much…”

This could have important implications in the worker’s compensation and personal injury settings.  Pain presents a particularly difficult conundrum in the medico-legal context because we are frequently dealing with persons who have (or allege) an injury overlaying a significant degenerative disease processes like osteoarthritis or degenerative disk disease that, to put it simply, hurts.  In an effort to improve functionality, it seems like the goal of treatment is often to eliminate or reduce pain, which has predictably poor results in the context of a chronic, degenerative condition like degenerative arthritis.  The Reynolds article and the study on which it is based suggest a different approach may be in order.  Rather than telling patients that pain is bad and needs to be eliminated, perhaps patients need to be told that pain isn’t so bad and that they can take it.  According to Mr. Jones, “the brain begins to accept that we are tougher than it had thought, and it allows us to continue longer although the pain itself has not lessened.” 

This validates the advice we frequently see from independent medical experts who frequently note that patients suffering from progressively deteriorating degenerative conditions such as osteoarthritis need more activity not less and less treatment not more in order to maximize function and to learn how to live with the realities of a degenerative condition.  It will be a positive development if the study’s results can be replicated and exercise can become a standard, first line treatment for conditions causing chronic pain.  Instead of downward spirals into depression and dependence, perhaps we will see more patients take control and increase their independence and engagement.  This alone would have an enormously positive impact on worker’s compensation and personal injury claims.

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