Chiropractors that incorporate exercise can further reduce chronic pain, research says

New research in a story from NPR is reaffirming the opposite of what health care providers believed for the longest time — that chronic pain suffers should exercise to relieve pain rather than staying immobile.

While moving was thought to make the pain worse for chronic pain sufferers, researchers now say the opposite is true and that with the help of the brain, exercise can help reduce the pain

“With chronic pain, the body almost gets into this downward spiral where…you get fearful of movement, then you don’t move, then you get weak, then you get more pain,” says Douglas Ebner, a physical therapist at Ohio State University Wexner Medical Center, speaking to U.S. News and World Report. “Then they don’t want to do anything, and then they get even weaker.”

One case in point NPR pointed out is 44-year-old Emma Dean who has had osteoarthritis in both knees since a young age. As a worker at the Thurston Arthritic Research Center at the University of North Carolina, she became involved in a study where patients with osteoarthritis were encouraged to get out and start walking to reduce pain.

“I felt stiff and I felt tired and out of breath, but literally after a few days I started to feel looser in my joints, I wasn’t as out of breath, and my mood started to improve,” said Dean, who worked her way up to walking for 45 minutes five times a week, speaking to NPR. “Now my knee feels like it did when I was young, it doesn’t hurt me anymore.”

The positive results are partly mechanical, as exercise builds muscle and reduces stiffness and inflammation, which all reduce pain. The results are also partly due to how the pain perceives chronic pain.

Researcher are also finding that exercise changes pain in the brain when the body produces natural opioids due to exercise. The brain uses the natural opioids to decrease pain, with the opioids binding to the same receptors in the brain as narcotics would. The extreme case of this is the “runner’s high” where the body produces so many opioids there is a significant brain boost and body sensation.

“With chronic knee pain we actually recommend people stay active,” says Dr. Amit Momaya, an assistant professor of orthopedic surgery at the University of Alabama at Birmingham and medical director of UAB’s sports medicine clinic. “Counterintuitively, exercise can sometimes protect the knee, keep it in a better health state — even when you have chronic pain in the knee from arthritis.”

Other parts of the brain that decrease pain, researchers say, are also activated by exercise, and this exercise also seems to decrease stress, which can make people more sensitive to pain.

The news is good for chiropractors who incorporate wellness, exercise, physical therapy or weight loss into their practices, since the majority of chiropractic patients are seen for chronic back or neck pain.

“About 25% of [chiropractic] offices use rehab protocols or exercise as therapy, which can add value to your office, create better outcomes and generate revenue,” wrote Jeffrey Tucker, DC, in the May issue of Chiropractic Economics magazine regarding future trends. “Getting people to be more physically active, quit smoking, control food portions and diet, improve sleep, decrease stress, are not well implemented [by chiropractors]…yet.”

Researchers says there are hundreds of studies pertaining to opioids or pain killers and chronic pain, but virtually no studies or data regarding exercising and chronic pain. What little research has been done has resulted in studies showing exercise five or more times a week as ideal for combating chronic pain as opposed to 1-2 times a week.

The results are similar to Stanford researchers who have debunked putting heart failure patients on low- to no-exercise regiments. Research has shown that walking or low-impact exercise for heart failure patients strengthens the heart, improves circulation, and reduces heart failure symptoms among other benefits.

Chronic pain can be debilitating, and in the past has lead patients and doctors to avoid exercise which would seemingly cause more pain. Now research is showing even the smallest of exercise for chronic pain patients, built up over time, can alleviate pain with the help of the brain. Paired with chiropractic care, chiropractic and exercise are providing research-based alternatives to opioids and other drugs for pain.

To learn more about the study results and researchers involved go to https://www.npr.org/2019/09/09/758943492/exercise-can-help-reduce-chronic-pain-researchers-say.