Increasing Activity and Improving Function in Chronic Pain Management

Summarized by: Shelly Sontag

Chronic pain is a condition of complexity that requires a multi-dimensional approach. Unfortunately, not many patients who suffer from chronic pain are able to use a clinic or program that addresses chronic pain management due to their location or finances. The goal of this article is to give an overview of approaches that may be helpful to physiotherapists in their own practice relating to chronic pain.

Essential components that the article discussed for cognitive-behavioral pain management include:

• Education: Education should be engaging and effective. Education should include differences in acute versus chronic pain, what pain means, how exercise could help, pain gate theory, etc.
• Goal Setting and Pacing: It is important to set goals to have a good pace of increasing activity and to regulate activity. Goals should be set in three domains, physical, functional/task, and social. Pacing is important so the patient does not overexert themselves and increase their pain level, which can lead to decreases in the level of activity, further leading to physical deconditioning. Pacing of goals is important to lead to the feeling of mastering a task, but still needs to be challenging enough to have the patient progress.
• Physical Exercise: limited physical activity can be due to several reasons including tight scar tissue, muscle tension, avoidance due to pain or lost confidence, etc. Keep in mind that most patients do not have complete muscle wasting and reward them for what they do during the day rather than what they don’t; it is unhelpful to blame the patients or call them lazy; patients may provide defensive behavior in therapy to avoid increasing their pain; patents want to try to improve their condition so they may over exercise or under exercise due to past experiences; and once exercise has helped to give the patient confidence and improved function, more enjoyable activities are suitable. The two exercise components that should be included are stretching and range of motion exercises (to increased joint mobility and soft tissue length) and aerobic conditioning (to increase fitness level) as discussed further in the article. Continuation of exercises is more likely to continue if the provider makes it interesting and attainable.
• Reducing Pain Behavior: Pain behavior is often seen during exercise. It is important to acknowledge improvements and achievements, but not to ignore pain behavior. Pain behavior should be explained and acknowledged, but the focus of therapy should be on what they attempt to do rather than the pain.
• Relaxation: Relaxation may be a useful tool to use in adjunct to pain management. Some techniques that are used in combination and favored by patients include: imagery relaxation, autogenic relaxation, diaphragmatic breathing, and focusing. These techniques may help to give the patient a sense of control over their pain.
• Sleep management: Some ways to address sleeping problems is to check postures used during sleep, positioning changes, stretching, and the amount of rest and activity throughout the day.
• Relapse self-management: Most patients will have a relapse of chronic pain at some point. It is important that the patient has an ‘emergency card’ for flare ups. Therapists should ask the patient about their emergency card plan and other self-management strategies. These should be used and implemented to helping the patient. 

Harding, V., & Watson P. (2000). Increasing Activity and Improving Function in Chronic Pain Management. Physiotherapy, 86(12), 619-630.