Maybe the title has you wondering how something can be chronic and have treatments at the same time? It’s a good question to ask. To this day, there is no singular treatment for chronic pain. The drugs on the market help with the management of the symptoms of chronic pain, but not the healing of it. To facilitate the reading of the article, we’ll keep using the word treatment when we are referring to the options that ease pain. The main goal of this second article of the series is to present the different treatments, their advantages and their inconveniences.
If you haven’t had the opportunity to read the first article of this series, we strongly recommend it. It will help you understand the physiological mechanisms behind chronic pain.
Good to know : contributing factor
The problem in treating chronic pain is that each case is unique, but we can still find some directions in scientific evidence that can be generalized to the population living with chronic pain. The most important one is that the treatment needs to put the individual in the leader’s role. Meaning, the most efficient therapies are the ones that give the individual an active role in his treatment, instead of confining him in a passive role. Extrinsic therapies such as medications can alleviate symptoms, but they don’t lead to recovery. That includes manual therapy, medications, hydrotherapies, and many more. Conversely, therapies that work toward making the individual autonomous and active through the process have a better prognosis. The most common of these therapies are cognitive-behavioral treatment, adapted physical activity, and education. The latter is very important. The person needs to be able to understand and demystify the underlying mechanisms of their condition so they can act consciously. This article series is exactly built in this optic to inform you, so you can take charge of your condition. Finally, the treatment modality that seems to improve quality of life the most is multidisciplinary. Therefore, a mix of different methods integrated into daily life is recommended.
Pharmaceutical Treatments
You probably know that there is no “miracle pill” to eradicate chronic pain. As explained in the article “Chronic Pain 101,” chronic pain is a phenomenon that occurs in the absence of physical injury and results from multiple physiological, psychological, and social factors. No medication can address all three of these factors. However, in the case of conditions such as fibromyalgia, medications are often prescribed to alleviate the symptoms that significantly degrade a person’s quality of life. The symptoms that can be relieved or reduced by medication include insomnia, headaches, pain, mood disorders, and anxiety. However, each category of medication comes with side effects. Tricyclic antidepressants can cause constipation, dry mouth, dizziness, or brain fog. Gabapentinoids (anti-epileptics) can also cause dry mouth, increased appetite, swelling of the lower limbs, drowsiness, and concentration and memory problems. Another commonly used group of antidepressants is selective serotonin reuptake inhibitors (SSRIs). This group of medications can lead to decreased appetite, digestive problems, sleep issues (insomnia or drowsiness), restlessness, and headaches, to name a few.
Even though taking medication is an accessible solution, studies report improvements in pain sensation and functional abilities ranging from only 5% to 20% (Fitz et al., 2021). This data supports the initial premise: individuals who are passive in their treatment, instead of having an active role, have a lower chance of seeing an improvement in their condition.
Adapted Physical Activity as a Treatment
Among the solutions that involve putting the individual into action, physical activity (PA) proves to be the most effective. In fact, a literature review compiling the results of 381 studies involving 37,143 participants living with chronic pain (fibromyalgia and others) identified PA as having the greatest benefits on functional capacities and pain relief, surpassing cognitive-behavioral therapy (Geneen, 2017). More specifically, PA helps improve sleep quality, symptoms of anxiety and depression, pain intensity, and the impact of fibromyalgia on daily activities (Bodéré et al., 2020). However, similar to pharmaceutical treatment, PA must be tailored to the individual based on their needs, limitations, and abilities. The results indicate that cardiovascular exercise is the most effective for individuals with fibromyalgia, followed by resistance training and stretching.
The principle of training that seems to demonstrate the most effectiveness is progression. Regardless of the intensity at which a person starts training, they must ensure a progression in their training over time. In fact, one of the few long-term studies conducted observed that at low intensity and without any changes to the program, the benefits of cardiovascular activity reached a plateau after one or two years. Conversely, the group that modified and increased the intensity of their program saw the benefits of PA continue to increase throughout the five-year duration of the study.
Undoubtedly, due to its impact on all aspects of the body’s functioning, adapted physical activity has a significant impact on fibromyalgia and other health conditions leading to symptoms of chronic pain. Physiologically, physical activity helps produce and release “feel-good” hormones in the body. Dopamine activates the reward circuit and generates a sense of personal satisfaction. Endorphins are secreted in response to stress (yes, PA is a stress, but a calculated and beneficial one) to protect the body by creating a sense of well-being and by reducing anxiety, pain, and fatigue. Psychologically, PA helps develop a sense of self-efficacy, which is the belief in one’s ability to produce a certain result (Meyer and Verlhiac, 2004). Socially, PA can help reestablish connections or create new ones. Group physical activity is equally beneficial, if not more, than solo practice. Group physical activities have shown better adherence to PA, but this remains a matter of personal preference and interest. Finally, physical activity can also help individuals reintegrate into certain social circles (going for walks with friends, accompanying a partner on a bike ride, playing with children, etc.).
Everyone has a different relationship with physical activity. Many people have never been encouraged to engage in it, some have tried it and had negative experiences, and others feel apprehensive at the mere thought of getting out of breath. Conversely, a significant majority of people who try it adopt it for all the benefits mentioned earlier. If you belong to the first group (or even the second!), you may need guidance to identify your strengths and weaknesses, understand where to start to achieve your goals, and implement tools to turn your new initiative into a daily habit. Know that if you would like to discuss your personal situation with a kinesiologist, you can contact our team at any time here. Also, keep an eye open for the third article of this series which focuses on organizational and motivational methods to adopt and maintain good physical activity habits!
Text by : Mathilde Lessard, kinesiologist at NeuroMotrix
Reviewed by : Martine Lauzé, cofounder and kinesiologist at NeuroMotrix
Translated by : Kassandra McCullough, kinesiologist at NeuroMotrix
Bibliography
Meyer, T. & Verlhiac, J. (2004). Auto-efficacité : quelle contribution aux modèles de prédiction de l’exposition aux risques et de la préservation de la santé ?. Savoirs, , 117-134. https://doi.org/10.3917/savo.hs01.0117
Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane database of systematic reviews, 4(4), CD011279. https://doi.org/10.1002/14651858.CD011279.pub3
Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: an update on burden, best practices, and new advances. Lancet (London, England), 397(10289), 2082–2097. https://doi.org/10.1016/S0140-6736(21)00393-7
Fitzcharles, M.-A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2021). Nociplastic pain: towards an understanding of prevalent pain conditions. The Lancet, 397(10289), 2098–2110. doi:10.1016/s0140-6736(21)00392-5
Ministère de la Santé et des Service Sociaux. (2021). Algorithme de prise en charge de la fibromyalgie. Santé et Service sociaux du Québec. [Publication]. https://publications.msss.gouv.qc.ca/msss/fichiers/2021/21-947-01W_fibromyalgie.pdf
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