Wellness

Rest isn’t always the answer to chronic pain.

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Wednesday, June 04, 2014

It was July 1, 2008.

I was standing outside the Outpatient Center at Chestnut Hill/New England Baptist Hospital in Boston, better known as “boot camp,” and I was petrified. I had been in excruciating neck pain for more than six months. The burning, searing pain ran straight from the lower part of my neck across to my left shoulder, along the way triggering muscle spasms so severe that my head was chronically tipped to the left, a problem called cervical dystonia, or, alternatively, torticollis.

I had bone spurs, arthritically degenerating vertebrae, and spondylolisthesis, a condition in which one vertebra slides out of position over another. I had tried opioids, NSAIDS and acetaminophen, none of which cured me. I couldn’t walk the dog lest she jerk suddenly on her leash and send my neck into agony. I couldn’t even put on toenail polish—it hurt too much to bend over and crane my neck to see my toes. I was losing hope. Like many of the other 100 million American adults living in chronic pain, I didn’t want to be on drugs any more.

Peeking in the door at boot camp, I could see four or five physical therapists hovering over back and neck patients who were really going at it, doing impressively strenuous exercises on dozens of machines. Back extensions. Rotary torso twists. Lat pull-downs. Leg presses. Seated rows. Arm bikes. Precisely the moves that would send my neck and shoulders into spasm.

No way was I going to do this. First of all, it would hurt like crazy. Second, I was sure that one false move would cause a bone spur to slice through my spinal cord, turning me into a quadriplegic. It was obvious: pain equals damage. Therefore, any movement that triggered more pain was going to make me worse.

How wrong I was. My happiest discovery, throughout my unwanted journey in the world of chronic pain, was the growing array of non-drug treatments that actually help.

Chief among these is exercise. Among the pioneers in treating pain with exercise is Dr. James Rainville, a spine and rehabilitation specialist at New England Baptist Hospital in Boston.

“To date, there is no scientific evidence that activity and exercises are harmful, or that pain-inducing activity must be avoided,” Rainville told me, and that’s especially true for back pain.

Indeed, to the contrary, empirical evidence suggests that activity and exercise that challenge physical impairments actually result in an improvement in chronic back pain.

Even “aggressive” exercise (that’s Rainville’s word) does not raise the risk of more back problems in the future. Current medical literature suggests that exercise has either a neutral effect or may slightly reduce risk of future back injuries. In other words, people with chronic low back pain, he stressed, should get out and “exercise, run, ski [and] play sports as they desire.” Exercise is a great way to prevent chronic pain.

The epidemiological evidence is overwhelming—the more a person exercises, the less likely he or she is to wind up with back pain. In 1997, Danish researchers tracked 640 school children over 25 years and found that those who were physically active for at least three hours a week had a lower life-time risk of back pain.

In 1998, Finnish researchers studied 498 adults and found that the fittest people had the lowest risk of back problems. In 1999, British researchers studied 2,715 adults without back pain and found that it was not physical activity that increased the risk of low back pain later on, but poor health and being overweight.

And in a 2011 study of 46,533 adults, Norwegian researchers found that among young and middle-aged people, the prevalence of chronic pain was 10 to 12 percent lower for exercisers. The difference was even bigger—a whopping 21 to 38 percent—among women aged 65 or older and, with slightly less dramatic numbers, among older men, too.

Even more important, for people already suffering from chronic back pain, the evidence is also overwhelming that exercise can be an effective and safe treatment.

In 1992, for instance, Swedish researchers randomized 103 low back pain sufferers to a carefully graded exercise program. All were blue-collar workers on sick leave for disability. The people who got exercise training returned to work much faster than those who did not.

A 2000 study by Finnish scientists came to similar conclusions. So did a 2004 Dutch review of data from 14 randomized controlled trials, a 2005 Swiss study, a 2010 review of nine studies involving 1,520 people, and a 2010 Dutch review of 61 studies involving 6,390 people. More recently, a 2011 Italian study of 261 people with chronic low back pain showed that those who stuck with a 12-month physical activity program wound up with significantly improved overall health, as well as significant reduction in pain, compared to 310 similar patients who did not.

It’s now 2014, nearly six years since I stood anxiously outside “boot camp.” Here’s what I’ve learned: Don’t shy away from opioids and other drugs if you really need them; they’re not as dangerous as press reports would have you believe.

But make non-drug treatments, particularly exercise, your first line of attack. It’s the non-drug treatments that will help you grow physically and mentally stronger and feel than you are at least somewhat in charge of your pain, not the other way around.•

Judy Foreman is the author of A Nation in Pain: Healing Our Biggest Health Problem (Oxford University Press, 2014).

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