Physical Activity Can Protect Against Chronic Pain

By Pat Anson, PNN Editor

Chronic pain sufferers are often told that physical activity and exercise can help reduce pain and improve quality of life. Now there is evidence that even light or moderate activity can have a protective effect against pain that lasts for years.

“We found that people who were more active in their free time had a lower chance of having various types of chronic pain 7-8 years later,” says Anders Årnes, a doctoral fellow at The Arctic University of Norway and University Hospital of North Norway.

“This suggests that physical activity increases our ability to tolerate pain and may be one of the ways in which activity helps to reduce the risk of developing severe chronic pain.”

Årnes is the lead author of a study, recently published in the journal PAIN, that found even light physical activity was associated with a 5% lower risk of developing chronic pain that lasts at least three months. More rigorous activity was associated with a 16% reduced risk of widespread moderate-to-severe chronic pain.

The findings are based on data from a large health survey -- the Tromsø Study --- in which over 6,800 Norwegians answered questions about their overall health, pain levels and physical activity, first in 2007-2008 and then again in 2015-2016. The average age of participants was nearly 55. Most reported some form of chronic pain, but only 5% had widespread moderate-to-severe chronic pain.

In a 2023 analysis of the survey data, Årnes and his colleagues found that people who reported vigorous physical activity had significantly more pain tolerance than those with a sedentary lifestyle.

Pain tolerance was assessed by how long they could keep a hand immersed in cold water that was a few degrees above freezing (3 degrees Celsius or 37.4 degrees Fahrenheit).

In their new follow-up study, researchers found that the ability to tolerate pain – or at least cold water -- plays a modest role in the protective effect of physical activity (PA).  

Stina Grønbech/Tromsøundersøkelsen

“We estimate that higher PA levels predict lower risk of chronic pain, with indications of a small mediated effect on this risk through cold pain tolerance for moderate-to-severe chronic pain states,” researchers reported.

Of course, many people with severe chronic pain are unable to exercise or fear that it will only make their pain worse. Previous studies have found that low-impact exercise programs, such as stretching while sitting in a chair, can ease pain from arthritis and other muscle and joint conditions.

“Physical activity is not dangerous in the first place, but people with chronic pain can benefit greatly from having an exercise program adapted to help them balance their effort so that it is not too much or too little,” said Årnes. “A rule of thumb is that there should be no worsening that persists over an extended period of time, but that certain reactions in the time after training can be expected.”

Even moderate physical activity can stimulate the production of endorphins and endocannabinoids – hormones and lipids naturally produced by the body -- which can relieve pain and inflammation. Regular exercise can also help us lose weight, reduce the risk of heart disease, and boost overall health.  

Regular Exercise Boosts Pain Tolerance

By Pat Anson, PNN Editor

People who remain physically active over a long period have much greater pain tolerance than those who are sedentary and don’t get much exercise, according to a large new study in Norway.

While exercise has long been touted as a way to ease or even prevent chronic pain, this particular study falls short in actually proving it, which we’ll get to later.

Researchers at University Hospital of North Norway analyzed data from 10,732 adults who participated in a large health survey -- the Tromsø Study --- that is conducted periodically in Norway. The researchers used data from two rounds of the study that were conducted seven years apart, one in 2007-2008 and the other in 2015-2016.

Most of the participants (79%) said they were either sedentary or engaged in only light exercise, while the remainder reported moderate or vigorous activity. About a third of the participants (32%) said they had chronic pain,

Pain tolerance was assessed by how long they could keep a hand immersed in cold water that was a few degrees above freezing (3 degrees Celsius or 37.4 degrees Fahrenheit).

The study findings, published in the journal PLOS ONE, showed that participants who reported vigorous physical activity in either round had significantly more pain tolerance than the couch potatoes who maintained a sedentary lifestyle in both rounds.

The good news for couch potatoes is that pain tolerance can be improved. As the chart below demonstrates, people who boosted their physical activity (PA) over time were able to keep their hands in cold water for longer periods, suggesting they have more pain tolerance.

source: plos one

“In summary, these findings suggest that becoming or remaining active at a level above being sedentary, or making a positive change in activity level, over time is associated with higher pain tolerance as opposed to being sedentary or making a negative change,” researchers reported. “Whatever you do, the most important thing is that you do something!”

Interestingly, having chronic pain did not influence the findings one way or another. Researchers found that chronic pain “does not significantly interfere” with the relationship between physical activity and pain tolerance. However, they were hesitant to draw a conclusion from that, saying the findings “might look different” if pain conditions were broken down into different diagnostic groups, instead of under one broad term under the label “chronic pain.”      

Even moderate physical activity is known to stimulate the production of endocannabinoids – cannabis-like substances naturally produced by the body -- which can relieve pain and inflammation. Regular exercise can also help us lose weight, reduce the risk of heart disease, and boost overall health.  

Active Seniors Have Lower Risk of Chronic Pain

By Pat Anson, Editor

Older adults who are physically active are better able to block pain signals and may have a lower risk of developing chronic pain, according to a small study published in the journal Pain.

Researchers at Indiana University-Purdue University Indianapolis performed a series of experiments on 51 healthy adults, aged 60 to 77, who wore monitoring devices for one week to measure their physical activity. Participants were given heat and pressure tests to measure their “pain modulation” – how the central nervous system interprets and perceives pain.

Both tests found that pain modulation was significantly related to physical activity. Older adults with more frequent moderate-to-vigorous physical activity had lower pain scores, while those who were sedentary were less able to block pain signals. Even light physical activity appeared to lower pain perception.

"This study provides the first objective evidence suggesting that physical activity behavior is related to the functioning of the endogenous pain modulatory systems in older adults," wrote lead author Kelly Naugle, PhD, of the Center for Physical Activity in Wellness and Prevention, Indiana University–Purdue University Indianapolis.

"Our data suggest that low levels of sedentary behavior and greater light physical activity may be critical in maintaining effective endogenous pain inhibitory function in older adults."

Previous studies have shown that pain modulation is poor in patients with chronic pain conditions such as arthritis, back pain and fibromyalgia.

Aging is associated with chronic low-grade inflammation and oxidative stress, which could make the peripheral and central nervous systems more sensitive to pain. Older adults are also more likely to be sedentary and less physically active, which would make them more vulnerable to chronic pain.

Recent studies have documented the benefits of exercise for older adults. Chair yoga reduced pain and improved the quality of life in older adults with osteoarthritis. Another study found that just 45 minutes of moderate exercise a week improved function and reduced pain levels.  

Even a Little Exercise Is Better Than None

By Pat Anson, Editor

We often hear from pain sufferers who say they’d like to exercise more, but can’t because their pain levels have left them bedridden or stuck on a couch. Others believe a workout at the gym will only make their pain worse.

But two new studies have found that you don’t need to be a gym rat to get the health benefits from exercise.

You may not even need to stand up!

Federal guidelines suggest a minimum of 150 minutes of exercise a week are needed to promote good cardiovascular health. But researchers at Northwestern University wanted to see if a lesser goal could improve overall health.

They measured the physical activity of 1,600 adults with osteoarthritis in their hips, knees or feet; and found that just 45 minutes of moderate physical activity a week improved their function and reduced pain

"We were interested in seeing what kind of physical activity might be beneficial to promote good function down the road,” said Dorothy Dunlop, a professor of rheumatology and preventive medicine at Northwestern University Feinberg School of Medicine.

“We found moderate-intensity activity rather than light activity, such as pushing a grocery cart, to be more valuable to promote future function."

Using sophisticated accelerometers to monitor movement, the researchers found that participants who engaged in moderate activity, such as brisk walking, for at least 45 minutes a week were 80 percent more likely to improve or sustain high future function.

The findings, published in the journal Arthritis Care & Research., were true for both men and women. The beneficial effects of the exercise were also long term. About a third of participants improved or had high function after two years.

"The federal guidelines are very important because the more you do, the better you'll feel and the greater the health benefits you'll receive," Dunlop said. "But even achieving this less rigorous goal will promote the ability to function and may be a feasible starting point for older adults dealing with discomfort in their joints.”

"Even a little activity is better than none," she added

Chair Yoga Relieves Pain of Osteoarthritis

A second study at Florida Atlantic University found that “chair yoga” is an effective way to reduce pain and improve quality of life in older adults with osteoarthritis.

As the name implies, the Sit-N-Fit Chair Yoga program was developed to help those who cannot stand during exercise or participate in traditional yoga. Chair yoga is practiced sitting in a chair or standing while holding the chair for support.

IMAGE COURTESY OF FLORIDA ATLANTIC UNIVERSITY

In a study of 131 older adults who have osteoarthritis, participants attended 45-minute chair yoga sessions twice a week for 8 weeks.

Researchers measured their pain, pain interference (how it affects one's life), balance, gait speed, fatigue and functional ability; before, during and after the sessions.

Compared to a control group enrolled in a health education program, the chair yoga group showed a greater reduction in pain, pain interference and fatigue during the sessions, as well as an improved gait. The reduction in pain interference lasted for about three months after the chair yoga program was completed.

"The effect of pain on everyday living is most directly captured by pain interference, and our findings demonstrate that chair yoga reduced pain interference in everyday activities," said Ruth McCaffrey, emeritus professor in FAU's College of Nursing and co-author of the study published in the Journal of the American Geriatrics Society.

"The potential impact of this study on public health is high, as this program provides an approach for keeping community-dwelling elders active even when they cannot participate in traditional exercise that challenges their balance," said co-author and principal investigator Patricia Liehr, PhD, a professor in FAU's College of Nursing.

Osteoarthritis is the most common form of arthritis and the leading cause of long-term disability in older adults. It affects about a third of Americans over the age of 65.