Exercise is medicine for Australians living with chronic pain

30 April 2021

The global initiative to improve the lives of people with chronic pain was bolstered through the release of the UK’s National Institute for Health Care Excellence (NICE) guideline for pain management, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, earlier this month.

“With at least one in five Australians experiencing chronic pain today, it is a rapidly escalating health issue and carries a significant economic burden in lost productivity and health costs, within Australia and globally. Traditionally, chronic pain has been managed with medications, but due to increasing concerns over safety and evidence of limited effectiveness, non-pharmacological approaches are becoming increasingly adopted – such as exercise,” says Anita Hobson-Powell, Chief Executive Officer of Exercise & Sports Science Australia (ESSA).

“ESSA strongly supports the NICE recommendations that exercise therapy is an efficacious, economical, low risk and essential treatment for chronic pain. ESSA also acknowledges and supports the significant role that Accredited Exercise Physiologists (AEP) play in improving the lives of people with chronic pain.”

The NICE guideline provides a blueprint for pain management in the UK. The guideline emphasises the important role that exercise and physical activity have in improving experiences of pain and quality of life in people with chronic pain. The guideline recommendations for pain treatments to be person centred, individualised, and to evoke behavioural change by providing information and advice, will resonate with AEP clinical practice.

Exercise programs and physical activity is the first recommendation in the guideline concerning the non-pharmacological management of chronic pain. The Chronic Pain Committee (the Committee) made this recommendation based on extensive research showing better outcomes for pain, quality of life, and disability with exercise therapy compared to usual care.

In addition, the cost of exercise therapy has shown to be lower than usual care. The Committee highlighted the benefits of supervised exercise that considers peoples individual needs, preferences and abilities. Rather than one optimal exercise type, the Committee recommended a variety of exercise types including aerobic, strengthening, and mind and body exercise. 

The Australian Commission on Safety and Quality in Health Care’s draft Low Back Pain Clinical Care Standard (currently open for consultation) also recommends non-pharmacological care as the first response to non-specific low back pain, with a heavy focus on encouraging physical activity. It recognises that exercise therapy requires some level of oversight and, along with other physical therapists, AEPs are appropriately placed to provide advice and oversight to achieve movement and exercise goals in people with chronic pain, particularly where comorbid conditions are present, such as mental illness or chronic disease.

In 2019, the Australian Department of Health developed the National Strategic Action Plan for Pain Management (Action Plan) to improve the quality of life for people living with pain and to reduce the growing burden of pain for individuals and the community.

“As a result of this Action Plan, ESSA has been involved in a number of projects, including the recent workshop for the development of a Pain Management Health Practitioner Education Strategy, which is currently under development by the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. This project supports goal three of the Action Plan, to ensure health practitioners across all disciplines have access to consistent and evidence-based pain management education,” says Ms. Hobson-Powell.

Associate Professor and Accredited Exercise Physiologist, John Booth, is one of Australia’s leading authorities on the relationship between clinical exercise and chronic pain management.

“Just 20 minutes of yoga, aerobic, resistance, or other types of exercise can help with managing chronic pain. After one to two months of regular daily exercise, the benefits of exercise to people with chronic pain become more substantial through a range of positive changes in the body and brain,” explains Professor Booth.

“This includes the role of exercise in reducing inflammation and the release of neurotransmitters in the brain that act to dampen down the pain response. In contrast to pain medications that also target these outcomes, exercise is not associated with potential harmful side effects including dependency. There is no doubt that exercise is medicine for people with chronic pain and essential to their pain rehabilitation.” 

To find an Accredited Exercise Physiologist who can assist with managing chronic pain, visit ESSA’s online directory.