Overview of physical activity and managing chronic pain

Physical activity refers to movement of the body. It can be structured (eg walking groups, exercise classes, gym or pool-based exercise) or unstructured involving activities of daily living (eg playing, working, mobilising, house chores and recreational activities). Physical activity can be aerobic (endurance), or focused on strengthening, flexibility, coordination or balance.

Physical activity is a first-line management strategy for chronic pain. It can reverse or halt significant deconditioning that occurs with chronic pain, improve mood and functioning, and reduce the impact and severity of pain.

Physical activity needs to be ongoing, as part of a multidimensional approach.

People with chronic pain can find starting or maintaining physical activity difficult for a number of reasons, including:

• not knowing where to start, which can lead to overdoing or underdoing activity
• previous negative experiences
• fear that the activity will make the pain or condition worse
• physical deconditioning can make activity uncomfortable or difficult and new pain can arise (eg from muscle soreness, tendinopathy)
• fatigue related to physical deconditioning, medications etc
• low motivation
• feelings of loss, grief and social disconnection, especially if they had a high level of physical activity prior to pain onset—address these feelings alongside exploring new activities.

Additional difficulties for children and adolescents with chronic pain include:

• stress on family resources (eg financial, transport), which may limit activity choice
• reliance on parents and carers to guide them about the safe or expected level of activity
• social pressures from peers, which affects activity choice and may result in overdoing activities to keep up with peers.

Provide reassurance, positive reinforcement and support, especially when the patient has a pain flare, is struggling with motivation or misinterprets normal muscle soreness associated with recommencing activity. When appropriate, educate the patient’s parents and carers to enable them to confidently support the patient’s physical activity plan.

General practitioners and nurses can support patients (and their parents or carers) with self-management and physical activity goal setting. Often, children and adults with chronic pain see a community-based physiotherapist as part of their management plan to achieve their physical activity goals. If substantial improvements are not achieved within 3 months, refer the patient to an age-appropriate multidisciplinary pain service that has a specialist pain physiotherapist or occupational therapist; see The role of healthcare providers in chronic pain management. When fear of movement or demotivation cannot be overcome, the person may benefit from psychologist input.

For the role of physical activity in specific musculoskeletal conditions, see the Rheumatology guidelines.