CF 129: Updated Thinking On Chronic Pain and Exercise Today we’re going to talk about chronic pain and exercise. But first, here’s that sweet sweet bumper music OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
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- compare Exercise induced hypoalgesia in participants with chronic whiplash associated disorders to asymptomatic controls,
- determine if exercise induced hypoalgesia differs between aerobic and isometric exercise,
- determine predictors of Exercise induced hypoalgesia.
- A pre-post study investigated the effect of single sessions of submaximal aerobic treadmill walking and isometric knee extension on exercise induced hypoalgesia in 40 participants with chronic whiplash associated disorders and 30 controls
- Pressure pain thresholds were measured at the hand, cervical spine and tibialis anterior
- Appropriate baseline measurements were performed
- Hurt = harm
- activity is harmful
- if an activity hurts it should be stopped
- The patient decides what’s tolerable,
- Above 5 is the red area
- If pain increases with exercise, that’s OK as long as by the next day it has calmed.
- “The exclusive focus of the numeric rating scale (NRS) on pain intensity reduces the experience of chronic pain to a single dimension.”
- “This drawback minimizes the complex effects of chronic pain on patients’ lives and the trade-offs that are often involved in analgesic decision-making.”
- “Furthermore, continually asking patients to rate their pain on a scale that is anchored by a pain-free state (ie, 0) implies that being pain-free is a readily attainable treatment goal, which may contribute to unrealistic expectations for complete relief.”
- “ The overarching goal of chronic pain treatment is to make the pain tolerable for the patient rather than to attain a targeted numeric rating.”
- “Our findings confirmed the intuitive assumption that most patients with low pain intensity (ie, NRS score, 1-3) find their pain tolerable.”
- “In contrast, the tolerability of pain rated between 4 and 6 varies substantially among patients.
- “In this middle range, if a patient describes the pain as tolerable, this might decrease the clinician’s inclination to initiate higher-risk treatments.”
- “A substantial subgroup of patients with severe pain reported their symptoms as tolerable.”
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- Liebenson C (2020). “Pain with Exercise: Is it acceptable & if so how much & for how long?” First Principles Of Movement.
- Smith A, R. C., Warren J, Sterling M, (2020). “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise.” Clin J Pain.