Flexing against chronic pain

For people living with chronic pain, exercise is often the last thing they want to do. But physical activity could be a key component of some treatment plans, new studies suggest, especially with conditions such as fibromyalgia and arthritis.

“The pain doesn’t go away completely. It’s not a cure. But it’s a way to improve how you feel and your ability to function in daily life,” says Daniel S. Rooks, an assistant professor of medicine at Harvard Medical School and a researcher for Novartis Pharmaceutical in Cambridge, Mass. He was the lead author of a study, published in the Nov. 12 issue of Archives of Internal Medicine, suggesting that regular, moderately intense exercise can benefit many fibromyalgia sufferers.

The study of 135 women found that those participants who did a combination of walking, strength training and stretching three times a week for four months reported a significant easing of symptoms. (The workouts started at 30 minutes and gradually increased to 60 minutes per session.) In one group measurement, the degree of bodily pain was reduced by 45% after 16 weeks of exercise.

A total of 135 women completed the study and were evaluated six months later. All of the participants who exercised reported a significant reduction in the severity of their symptoms, Rooks says, leading the researchers to conclude that “appropriate exercise and patient education should be included in the treatment of fibromyalgia.”

In fibromyalgia, the brain incorrectly processes sensations, resulting in widespread pain throughout the body. Other earmarks of the condition include depression and problems with sleep and concentration.

“This is a disorder that has good days and bad days. The bad days are really bad,” says Dr. Stuart Silverman, a UCLA clinical professor and medical director of Cedars-Sinai Medical Center’s Fibromyalgia Rehabilitation Program.

FDA validation

The Food and Drug Administration recently approved pregabalin (brand name Lyrica) as the first drug to treat fibromyalgia. For many patients, the Pfizer drug is validation that they have a real medical condition, an acknowledgment they’ve long fought to obtain. But Lyrica can cause side effects – dizziness, drowsiness, weight gain and swelling – and experts do not consider it to be a panacea.

In the study led by Rooks, the authors wrote: “Even with the recent approval of pregabalin by the Food and Drug Administration to treat fibromyalgia symptoms, pharmacotherapy is often insufficient to resolve persistent symptoms or improve functional limitations and quality of life.”

About 30% of people taking Lyrica will see a 50% reduction in pain, Silverman says. He cautions: “Even if you take Lyrica, you still need to combine it with non-pharmaceutical approaches, like exercise.”

But when even getting out of bed sometimes is a challenge, the thought of exercising can seem daunting.

“You must listen to the symptoms,” says Jessie Jones, director of the Fibromyalgia Research and Education Center at Cal State Fullerton.

Jones, who has had fibromyalgia for 10 years, had been athletic and energetic before being blindsided by the sudden onset of intense pain and fatigue. When she first became ill, Jones began an odyssey of doctor visits in which she was either misdiagnosed or told the ailment was all in her head.

Gradually, she came up with a way to manage her symptoms. She describes herself as “drug-sensitive” and therefore does not take any medication; instead, she relies on a daily workout of dance movements, yoga, meditation and walking.

“My symptoms are under control, but I really, really work at it with a complete program,” says Jones, who is designing a Web-based guide for healthcare providers to help them diagnose and treat fibromyalgia.

Slow, steady progress

One goal of the online instruction, Jones says, is to show “there are more treatment options than just medication.” Some sufferers have found relief from bio-feedback training, nutrition strategies and stress management.

For many, exercise is the way to go. A study published in the November-December Journal of Clinical and Experimental Rheumatology found that exercise therapy done three times a week for 16 weeks in a warm-water pool significantly reduced the severity of fibromyalgia pain, while also improving cognitive function.

Experts in fibromyalgia and arthritis agree that anyone with a chronic pain condition should seek out exercise programs designed to meet their needs, such as ones offered by the Arthritis Foundation ([800] 954-2873) or some branches of the YMCA ([800] 872-9622). Gentle yoga, stretching, flexibility training and walking may be good choices. High-impact activities like jumping and running generally are not recommended.

“You have to start slowly and progress,” says Geri B. Neuberger, professor at the University of Kansas School of Nursing. She led a 12-week study that found low-impact aerobic exercise lessened pain, fatigue and depression among 220 men and women with rheumatoid arthritis, an auto-immune disease characterized by chronic inflammation, pain and joint deformity.

Similar results were found in research led by Leigh F. Callahan, an associate professor of medicine at the University of North Carolina’s Thurston Arthritis Research Center in Chapel Hill. In this study, published Jan. 15 in Arthritis Care & Research, 346 older adults with different types of arthritis and fibromyalgia participated in an eight-week exercise program developed by the Arthritis Foundation.

The twice-weekly, one-hour classes consisted of low-impact, moderate exercise, which could be done either sitting or standing. The participants (analyzed as a group) experienced a 23% decrease in pain, a 28% decrease in fatigue and a 19% decrease in stiffness. There was also improvement in upper and lower extremity strength.

One mystery not unlocked by researchers is why exercise helps those with chronic pain conditions. Experts theorize that chemical changes in the brain play a key role.

“We didn’t measure how exercise works,” Rooks says. “You have to assume that there are biological and psychological benefits to exercise that play a role in making people feel better.”

 health@latimes.com