Staying Active With Persistent Pain

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by Dr. Maureen Allen

Getting active with persistent pain can be a huge challenge.

Persistent pain or long term pain is a common condition experienced by 1 in 5 Canadians. It can feel similar to acute pain but the two conditions are very different.

Acute pain or short-term pain occurs when you have damage or possible damage to your tissue. Once your body repairs the damage your pain alarm should shut off.

Persistent pain on the other hand occurs long after tissue has healed. This pain is less about damage and more about the central nervous system which is part of your pain system.

The following post answers some frequently asked questions and contains tips on how to stay active with persistent pain.

Can persistent pain be cured?

There is no cure YET for persistent pain but our understanding of this life changing illness is growing. Unfortunately there is no blood test or X-rays that can confirm you have persistent pain. It’s because your pain has persisted more than 3 months and has never gone back to normal that it has received this diagnosis.

Persistent pain can also be found in illnesses like fibromyalgia, back pain, Crohn’s disease, migraines and irritable bowel disease just to mention a few. Despite the fact that these occur in different parts of your body the cause of the persistent pain is still the same: an amplified pain system.

Will activity help my pain?

ABSOLUTELY!! Our tissues are designed to move. When we stop using them they get weak and deconditioned. Because persistent pain is caused by a sensitized or amplified pain system, attempts to move your tissue may be painful and sometimes can result in a flare-up of your persistent pain. The important thing to remember is you are not causing damage by moving. It’s how you move that matters most. Activity needs to be done in the right way to minimize pain flare-ups. If walking is an activity you like to do, here is an example on how you might approach walking.

It’s good to plan a time for your walk the day before and be sure it’s on a surface that is flat with no hills. This calms the pain system and helps make life more predictable and less chaotic. Remember it doesn’t have to be perfect, the important thing is that you try.

Finding your activity tolerance

Activity tolerance is the amount of activity you can do on a good pain day and a bad pain day that will not cause an increase in your daily pain intensity.

Your daily baseline pain is the intensity of pain you experience on a daily basis that is not a flare-up. In other words it’s the average or typical amount of pain you live with every day.

A flare-up however is an increase in your daily baseline pain that can leave you debilitated for hours, sometimes days. When this occurs the intensity of pain you experience may go off the 10 point scale.

Tips on staying active

1. Pay attention to the pain intensity
As you begin your walk, pay attention to the pain intensity you are experiencing. If your pain intensity is 5 on 10, how far can you walk before it starts to creep up to 7 on 10?

2. Calculate your activity tolerance
If you start to feel the pain intensity increase at ten minutes, calculate your activity tolerance or starting point by taking half that time or 5 minutes and plan your daily walk once or twice a day sticking to the 5 minutes. This may not seem like much, but it will be a safe amount of time that can be gradually increased over time if you do not experience any flare-ups.

If you prefer not to use time; distance or land marks may work better. In this situation the land mark you choose which caused an increase in your baseline pain should be cut in half.

It doesn’t matter if you use time or distance to find your activity tolerance. It’s whatever works for you. There is no right or wrong way.

3. Plan ahead
Now that you know the ideal time or distance to avoid a flare-up, plan the best time of day for your walk. On the day of your walk do not let pain sabotage your plan. It is important to try. Remember you’re not causing damage by moving.
It may seem like you’re not doing much at this stage, but research shows that using activity in this way can help to re-train or re-boot your pain system. Minimizing flare-ups are essential to calming pain. Be patient and gentle with yourself.

4. Plan your progression
If you were able to walk for 4 days at the distance and time you picked then you can add a minute to your time. If you use distance, pick a new target on your route that feels safe but still challenges you to nudge the edges of your pain.

5. Don’t get discouraged
Sometimes despite your good planning a pain flare-up may occur the next day or a few days later. Don’t panic or get discouraged. When this happens your time or distance may need to be adjusted or you may need to look at how your day is structured.

You are not alone

Remember you are more than just a person living with pain. You have dreams and aspirations like everyone else.  Begin to take the steps to help you move forward.

Talk to your health care provider to see if a referral to a pain self-management program may be beneficial for you. It may help you explore other activities that could be more suitable for you and your abilities. Be open to trying different things. Look at what your community has to offer.

Maureen Allen, MDDirector of Emergency ServicesSt. Martha’s Regional Hospital

Antigonish, NS

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