Exercise a Mainstay for Managing Chronic Pain

Treatment of chronic nonmalignant pain requires a comprehensive approach combining pharmacological and nonpharmcological interventions, but encouraging an increase in physical activity should be integrated into the management plan for all affected patients, said Matthew Hollon MD, MPH, assistant professor of general internal medicine, University of Washington, Seattle.

In fact, said Hollon, exercise is probably the best of all nonpharmacological interventions, especially in patients with low back pain and fibromyalgia. The mechanism for the benefit of exercise may be the equivalent of the relief derived from physically rubbing a banged elbow and involve delivery of sensory input to the brain that is not driven by sensory pain fibers.

In counseling patients about exercise, advise them to start small, perhaps with a walking program, but tell them they need to exercise no matter what, said Hollon. Also instruct them to keep a diary in which they actively record days when they do not exercise as well as days when they do.

Referring the patient to a physical therapist might be helpful for initiating an exercise program in the reluctant patient, and clinicians should be prepared to respond to individuals who are adamant that they are unable to exercise because of their pain.

"Acknowledge that exercise may hurt at first, but tell them there is a good chance that by starting with a little daily exercise and slowly increasing the amount, the body will get stronger and you'll be better able to cope with your pain," Hollon counseled.