Break the Cycle of Chronic Pain

From the Lecture Series: The Mayo Clinic Guide to Pain Relief

By Barbara K. Bruce, Ph.D., L.P., Mayo Clinic Department of Psychiatry and Psychology

Pain affects more Americans than diabetes, heart disease, and cancer combined. If your life has been hijacked by pain, triggered by arthritis, chronic fatigue syndrome, disc problems, fibromyalgia, headaches, sciatica, or other causes, read these tips to successfully manage chronic pain.

Stethoscope on wood with Pain Management words as medical concept
(Image:  Lemau Studio/Shutterstock)

A New Approach to Pain Management

There was a time, not so long ago, when people who had chronic pain were told to avoid exercise and exertion. Practitioners thought that their patients might do themselves more harm than good by aggravating injured joints and muscles.

Today, we know the opposite is true. Study after study, case after case, shows how exercise not only improves people’s overall health but also actually reduces pain symptoms and improves their quality of life.

Learn more about common causes of chronic pain

Exercise produces many health benefits. It releases endorphins and enkephalins—the body’s natural painkillers and feel-good hormones. 

Exercise releases endorphins and enkephalins—the body’s natural painkillers and feel-good hormones.

It improves blood flow to the brain, reduces fatigue, improves the quality of your sleep, and it may even reduce the risk of Alzheimer’s disease and certain forms of cancer. New research demonstrates how exercise can help you build emotional resilience as well as physical strength.

Break Out Of The All-Or-Nothing Exercise Trap

girl performing lunges with dumbbell in gym
Make exercise work for you. (Image: LightField Studios/Shutterstock)

The secret to making exercise help, rather than hurt, is moderation. That’s a struggle for a lot of us. We usually gear ourselves up to conquer that work-out and push ourselves to do it all. Yet the result is a rapid crash and burn and a worsening of our pain symptoms. But exercise doesn’t have to be that way. The best strategy is to break out of that all-or-nothing, push-it-to-the-limit mindset and learn ways to make exercise work for you.

This is a transcript from the video series The Mayo Clinic Guide to Pain Relief. Watch it now, on Wondrium.

The secret to making exercise help, rather than hurt, is moderation, and the best place to begin is by building strength, endurance, and confidence. Here are three steps to help you succeed:

  1. Guidance: any exercise/well-being steps you choose to implement should be customized to your particular needs with the help of your doctor, as well as a professional physical therapist or trainer.
  2. Moderation: Start by going for a 10-minute walk three times a week. If that wipes you out take a different approach—walk two or three minutes a day, every day—less exercise, more frequently so that you can very gradually increase your strength and endurance, but not get into trouble with your pain.
  3. Goal: as you conquer the two minutes a day, set a new goal and move up to four, then to six, then eight, and so on—every two weeks. Continually raising the bar as each new goal is met, gradually working your way to your ultimate goal, maybe 30 minutes of walking every day. With this structure, you’ll become strong enough to endure the physical demands of walking and become confident in your ability to do it.

Learn More: Medication For Chronic Pain: Why and Why Not

Types Of Guidance

There are three different types of trainers that might be helpful to you, depending on your specific needs.

  1. A physical therapist is trained in the use of exercise to achieve physical fitness or rehabilitation from injury.
  2. An occupational therapist will help you learn how to safely perform everyday activities without aggravating your injury or pain—activities such as lifting, reaching, and even getting dressed.
  3. A certified exercise therapist, much like a physical therapist, is trained in helping you achieve general physical fitness. But these therapists work outside the clinical setting, usually in gyms and health clubs. A certified exercise therapist is different from a simple personal trainer and has more expertise in dealing with injured individuals.

Addressing Maladaptive Behaviors

When people live with pain, especially chronic pain, they tend to become inactive.

This inactivity may not be causing the chronic pain, but it can feed into the chronic pain in several different ways by leading to poor endurance, to weakness, to overall fatigue, and to what is called maladaptive behaviors.

Female physiotherapist assisting a male patient while exercising in the clinic
A physical therapist is trained in the use of exercise to achieve physical fitness or rehabilitation from injury. (Image; wavebreakmedia/Shutterstock)

Maladaptive behaviors are behaviors that help you cope with one problem, but in doing so, they cause another problem. Imagine that you have an injury in your left knee. You might be bearing too much weight on your right leg to compensate, leading to pain in both knees. That’s maladaptive behavior.

To begin, you need to address your inactivity, your poor endurance, and any maladaptive behaviors you’ve developed to manage your pain. Create a program that not only deals with the site of pain and any adaptations you’ve gotten used to, but that promotes general physical fitness and well-being. The goal is to be strong enough to live your life—to be able to bring the groceries in from the car, walk up the stairs—pick up your pots and pans to cook dinner.

Use SMART Goals For A Smart Exercise Routine

Perhaps you’ve heard of SMART goals before. They’re used by businesses, schools, organizations, and individuals of all kinds. They’re a wonderful tool to create sustainable plans.

Learn More: How To Sleep When You Have Pain

SMART is an acronym. It stands for—Specific, Measurable, Attainable, Relevant, and Time-limited. When you design your goals, they should meet all five of these criteria. Here’s how it works.

  1. Is it specific? Know exactly what you want to achieve—to be healthy and mobile enough to _________.
  2. Is it measurable? For example: Walk for 30 minutes, once a day.
  3. Is it attainable? If your initial goal is just too much and wears you out, break it down so that it becomes more attainable. As mentioned above the goal can become to walk for two minutes a day, every day for two weeks and gradually work up to 30 minutes a day, without getting exhausted.
  4. Is it relevant? The purpose of a goal is to shift your focus from your pain to your life. Make the focus your ability to walk for a pretty reasonable amount of time and to feel steady on your feet. That would enable you to do other things—go grocery shopping, go to a party, stand in line at the movies, lead a pretty ordinary life.
  5. Is it time-limited? A time-limited goal is one you need to complete it by a specific date. Set an original date that is achievable.  If you need to, move the deadline back a few months. Never eliminate the deadline altogether. That’s important, as deadlines motivate you and give you a clear target to work toward.

When setting a goal, make it specific, measurable, attainable, relevant, and time-limited. It’s a SMART goal. What is your goal?

A Note Of Caution

Have you ever bought an exercise video or book that opens with a disclaimer like: Talk to your doctor before starting any physical exercise program? That’s not just legalese.

Before you even meet with a therapist, you need to talk to your primary care provider. This is especially important if any of the following applies to you: if you have heart disease, if you have asthma or lung disease, if you have type 1 or type 2 diabetes, if you have kidney disease, if you have arthritis, if you’re being treated for cancer, or you’ve recently completed cancer treatment.

Keep in mind is that if you have a personal health history that may impact your exercise plan, talk to your doctor first.

This is not meant to scare you off from physical activity, but quite the opposite. The idea is to make sure that you’re taking part in the types and amounts of exercise that are best for you—make sure that it’s safe so that you’re getting every possible benefit you can out of your physical activity.

With that being said, there’s no better time than the present to start your new life of pain management and exercise!

Common Questions About Managing Chronic Pain

Q: How do you manage chronic pain?

To manage chronic pain, reduce sources of stress in your life and implement an exercise routine. This routine can be as simple as light walking a few minutes a day, but you should gradually increase the duration and intensity of your exercise routine over time.

Q: Does chronic pain go away?

Chronic pain, unlike acute pain, is long-lasting. Chronic pain can be caused by conditions such as cancer, arthritis, or nerve damage. Although your pain may not disappear, you can take steps to manage your pain.

Q: What does chronic pain do to a person?

Chronic pain is not just physical—it can also bring on mental symptoms such as depression, anxiety, and anger. Exercise, massage, and therapy are all tools that can help you to cope with the pain and resulting symptoms.

Q: How do you fix chronic pain?

The best way to cope with chronic pain is to take your mind off of it. Meditation, light exercise, group therapy, and being in nature can help you so that you’re not so focused on your pain.

This article was updated on April 14, 2020

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The Mayo Clinic Guide to Pain Relief
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