Chronic pain is debilitating on a number of levels. Aside from the physical pain, there’s the emotional and psychological impact of reduced mobility, potential loss of income and independence, and cascading effects on loved ones. These factors can further lead to depression and other second-order issues, including overall reduced quality of life. Obviously, the best scenario is one in which the underlying cause(s) of pain can be identified and addressed, but for many people the cause or causes remain elusive, and for some, even when they can be identified, they may not be correctable. This can be devastating for the approximately 50 million Americans living with chronic pain (about 20% of the adult population). Fortunately, these individuals aren’t destined for a lifetime of physical and psychological suffering. Although properly administered and monitored pharmaceutical drugs can be helpful, there are also non-pharmacological strategies that can ameliorate pain or boost resiliency to improve quality of life even when the pain is not completely resolvable. Here we’ll explore three evidence-based daily strategies for managing pain.
Moving around and being physically active might sound counterintuitive for people living with chronic pain, but staying active can help maintain the ability to perform everyday tasks, which ultimately supports being able to live independently. It’s important to tailor the intensity of one’s activity to their condition and/or intensity of pain. High-intensity interval training may be fine for someone healthy and strong, but it’s not for those living with complex pain syndromes. Dr. David Brady, author of The Fibro Fix, a comprehensive dietary and lifestyle strategy for fibromyalgia, said it well: “Not enough exercise, as well as too much, can worsen pain syndromes. […] You know the old adage, ‘No pain, no gain’? Forget it! It doesn’t apply to you.” Dr. Brady recommends “exercise with an emphasis on mobility and stretching, using gentle movement exercises as well as activities such as walking or yoga.”
Research on exercise and physical activity for chronic pain is mixed, largely due to the inherent individual variability with regard to which type of exercise is best for a particular condition and for a specific individual. (Not to mention optimizing intensity, frequency, and duration.) Overall, it’s been shown uniformly that low-to-moderate intensity exercise (defined as 50-60% of maximum heart rate) tends to improve chronic pain symptoms. Strength training employing free weights, machines, elastic bands, body weight, or resistance against water (aquatic training) has also been shown to be supportive for managing pain in fibromyalgia and chronic pain. Patients should work with a qualified healthcare professional to develop a program that’s appropriate for them.
Physical activity not always classified as “exercise” can be helpful as well. A meta-analysis of randomized trials evaluating the efficacy of dance for improving pain in patients with fibromyalgia found that programs calling for 60-120 minutes of dance 1-2 times per week for 12-24 weeks resulted in a large reduction in pain scores, as well as significant improvement in depression, anxiety, physical function, impact of the disease, and quality of life. (As we’ve written about in the past, dance is also great for people who don’t have chronic pain, especially older people.) Qigong, considered “meditative movement” or “mindful exercise” may also have a therapeutic role in helping to manage chronic pain, specifically from fibromyalgia.
Perhaps the biggest factors in support of exercise as a modality for managing pain are that it’s safe and nearly cost-free. Except for the cost of comfortable shoes or a one-time expenditure for resistance bands or dumbbells, walking, gentle stretching, and low-level resistance training can be done in the comfort of one’s home or in the surrounding neighborhood.
Don’t Forget to Laugh
As we covered awhile back, laughter can be a powerful adjunct to medical care. Laughter lifts the spirits, and it can also have an ameliorating effect on physical pain. As Groucho Marx said, “A clown is like an aspirin only he works twice as fast.” Someday healthcare practitioners might even write prescriptions for laughter. (“Watch two funny movies and call me in the morning!”)
According to a publication from the Royal Australian College of General Practitioners, by helping to induce relaxation, laughter can increase pain tolerance by enhancing the brain’s responsiveness to endorphins, causing muscle relaxation, reducing hypervigilance and desensitizing central pain pathways, enhancing mood and reducing emotional reactivity to pain. Laughter might also have a direct physical effect on muscle pain: various muscle groups are activated for short bursts of time during laughter, but muscle relaxation prevails when the laughter subsides—for up to 45 minutes in some cases.
There’s a reason clowns are becoming common sights in hospital pediatric wards. Interacting with clowns and getting a dose of humor and levity has been shown to reduce pain and anxiety in children admitted for invasive procedures. A small study of subjects age 2-15 showed that the presence of a clown significantly reduced pain and distress during blood draw or IV insertion.
And don’t forget that unlike pharmaceutical drugs, laughter has few to no discernable adverse effects and as one author stated, “laughter is practically lacking in contraindications.”
It can be difficult for someone living with chronic pain to shift focus away from their condition and onto the good things in their life, but research indicates this can play a role in reducing pain and the psychological catastrophizing of pain that can worsen the physical sensation.
A study looking at relationships between optimism/pessimism, positive/negative affect, and goal adjustment and activity patterns in patients with chronic musculoskeletal pain noted that “positive affect and optimism are two of the most important resilient resources for successful adaptation to acute and chronic pain.” The study showed that compared to chronic pain patients who were more pessimistic, those who expressed higher levels of optimism reported being more persistent in pursuing their goals, better able to adjust goals to their individual situational constraints, and to more easily make new goals when faced with goals made unattainable by their condition. More frequent use of these flexible strategies was associated with higher positive affect, which was in turn related to persistence in finishing tasks or activities despite pain, something that could support better quality of life and increased independence. The researchers speculated that individuals with a positive affect might be better able to “broaden and build,” referring to stepping back to appreciate the larger picture of their lives rather than seeing their lives as pain-centric.
Other studies echo these findings, showing optimism to be positively correlated with reengagement, flexibility and tenacity in patients with chronic pain, and that these qualities were associated with higher levels of purpose in life. A study of older patients (age 45-85) with pain from symptomatic knee osteoarthritis found that an optimistic disposition positively influences pain perception, in part by reducing pain catastrophizing, and that patients who were more pessimistic may require additional treatment to manage the increased pain perception resulting from catastrophizing. In a systematic review of optimism and the pain experience, 70% of 69 total included studies found that optimism was positively associated with improvement in at least one pain outcome.
Positive correlations between optimism and reduced pain have also been demonstrated in the pediatric population. A small study of children and adolescents (age 8-17) with chronic pain determined that “optimism contributed to better functioning by minimizing pain-related fear and catastrophizing.” Pain intensity, fear of pain, and catastrophizing predicted overall functioning, and the calming influence of optimism “was a unique predictor of quality of life.”
For those to whom optimism and a positive mental outlook don’t come naturally, mindfulness strategies, self-help resources, and positive affirmations can help train the mind, slowly but surely, to see things in a better light. Cultivating a positive mindset, seeking out humorous movies and books, and engaging in physical activity are three simple, cost-effective, and non-invasive ways to chip away at the behemoth of chronic pain.