Movement therapies may reduce chronic pain

For more than a decade, Cheryl Clark has lived with the chronic pain that accompanies fibromyalgia. After years of suffering with severe flu-like aches and pains, she finally found some relief — but it didn't come from a pill or a shot. It came from exercise.

Several times a week, Clark heads to the warm-water pool and the gym at Casa Colina Centers for Rehabilitation in Pomona. Her pain, she says, has gone from a six or seven on a 10-point scale scale down to a one or two.

"It would kill me to walk from the car to the doctor's office. I was using a cane. I didn't have the mind-set that moving is the key … I really got my life back."

Movement-based therapies such as yoga, tai chi, qigong and more mainstream forms of exercise are gaining acceptance in the world of chronic pain management. Many pain clinics and integrative medicine centers now offer movement-based therapy for pain caused by cancer and cancer treatments, rheumatoid arthritis, fibromyalgia, multiple sclerosis, and other diseases and conditions. And Loyola Marymount University in Los Angeles offers a three-year yoga therapy course as part of the school's yoga studies program.

Several small studies in peer-reviewed journals attest to the effectiveness of these therapies.

In one, 30 men and women with chronic low back pain took hatha yoga classes for 12 weeks or were part of a control group that had standard care. Those in the yoga group had substantial decreases in pain compared with the control group, which had almost no change. At the end of the study, published in 2009 in the journal Alternative Therapies in Health and Medicine, the yoga group was also using fewer analgesics and opiates for pain, and reported greater overall improvement in quality of life.

Another study, published this year in BMC Musculoskeletal Disorders, found tai chi beneficial for 15 patients with rheumatoid arthritis. After practicing tai chi twice a week for 12 weeks, participants reported less pain and stress, plus more body awareness and confidence in moving.

And a 2003 study in the Journal of Rheumatology found that 43 people with osteoarthritis who completed a 12-week tai chi program had considerably less pain and stiffness in their joints and more abdominal strength and better balance compared with those in a control group that did not do the exercises.

Staying active

As for why movement can help tamp down pain, some health professionals believe it has to do with the overall benefits of helping people become active again.

"When pain gets chronic, people do less," says Kathleen Sluka, professor of physical therapy and rehabilitation science at the University of Iowa. "Their muscles get weaker and their bodies get tighter, and they think about pain a lot more. Movement techniques help them relax, make them stronger and reduce stress levels, so maybe they can think about something other than pain for a bit."

Further, common elements of yoga and tai chi include slow, rhythmic movement and diaphragm-focused breathing. Those elements alone may trigger a relaxation response.

"There is some evidence that as you do regular breathing and slow the heart rate, you can calm or quiet the autonomic nervous system," says Dr. Vernon Williams, director of sports neurology and pain management at the Kerlan-Jobe Orthopaedic Clinic in L.A.

When that happens, Williams adds, there may be reduced levels of cortisol and epinephrine, or adrenaline, in the body. Those hormones are released when the body is under stress. Small amounts can improve memory and energy levels, but too much over long periods of time can increase inflammation, as well as joint and muscle pain.

That inflammation, says Dr. Michael Irwin, professor of psychiatry and biobehavioral science at the UCLA David Geffen School of Medicine, could lead to increased pain sensitivity.

Slow, rhythmic breathing and movement "target the pathways by shutting off or diminishing the inflammatory response," he says.

More strenuous activity, for those who are able to do it, may also ease pain.

Cardiovascular exercise that elevates the heart rate for sustained periods helps the body release endorphins, neurotransmitters that attach to opiate receptors in the brain. That process can reduce the perception of pain.

It takes time

But exercise isn't a magic pill, and it may take weeks or months of dedicated work to see significant results.

"With any exercise program, you may get an initial increase in pain when you start, and you may feel it where the original pain is," says Sluka. "That's normal, but if people stick with it, that won't happen anymore."

The evidence on the benefits of exercise is good enough to convince many physicians to recommend movement therapy for some patients with chronic pain, but others think more research is needed.

"What we really want to know is long-term data," says Dr. Roger Chou, associate professor of medicine at Oregon Health and Science University. "Presumably, if these therapies are having an impact on the cellular level, they won't be a temporary placebo — they're going to last longer."

Knowing more about how movement affects pain can help tailor therapies to patients.

"If you can understand the underlying individual characteristics of an intervention, then it matters," says Jeffrey Gold, director of the Pediatric Pain Management Clinic at Chlidrens Hospital Los Angeles. "That way you're not wasting the person's time trying something. At the end of the day, when you have somebody with a debilitating condition, they can take part in a specific therapy, and it helps."

As for Clark, after completing Casa Colina's eight-week program, she continues to use the center's pool and gym several times a week. Exercising regularly has allowed her to stay in her 40-hour-a week job instead of going on disability.

"As you gain more endurance you can do more," she says. "And you feel better overall."