Join Prof Kathleen Sluka discussing the One Thing she wants people challenged by pain to know about. Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Kathleen.
About Kathleen Sluka
Dr. Sluka’s laboratory studies the peripheral and central mechanisms of chronic musculoskeletal pain. These studies primarily involve the use of animal models of muscle pain developed and characterized in her laboratory. Current projects are aimed at deciphering the role of descending facilitation from the medulla in initiating and maintaining chronic muscle pain. Here is Kathleen’s research profile.
Transcript
What is the one thing that you really want people challenged by pain to know?
So I’m going to tell you that I think the one thing that they really need to know was that exercise is the most effective multimodal treatment there is. And when I say that, what I mean is, it works on multiple mechanisms, on multiple different systems. It changes the central nervous system, it changes the peripheral nervous system, it changes the immune system, it changes psychology, it reduces the central sensitization, it reduces peripheral sensitization, it improves healing and promotes recovery from neuropathic pain. So it works across systems to help the patient not only improve function, which we all know it does, but to actually change the underlying causes of pain itself, the changes in the central and the peripheral nervous systems and the changes in the immune system.
The other thing that I think is super important about exercises, the most effective exercise programme that someone can do is the one that they will do. Because if you don’t do the exercise programme, it cannot work. And it turns out that number of studies have looked at different types of exercise programme and pitted them against each other in clinical studies, my favourite exercise programme against your favourite exercise programme, and most of them are not more effective than another one.
So what you really need to do is engage the patient and give them the choice and have them do what they will commit to. It doesn’t have to be high intensity exercise, it doesn’t necessarily have to be aerobic or strength training. Both of them work to reduce pain. It can be as simple as walking three times a week, it can be as simple as just increasing your activity and trying to get 10,000 steps a day. Or if you started at 2 going to 5000 steps a day. It’s really about increased activity and increased movement that are promoting these changes throughout our body to reduce pain signalling.
Are there any types of exercises that people with chronic pain shouldn’t be doing?
So I would say that the probably in it’s hard to say right because with chronic pain, there’s lots of different types of chronic pain and so outright saying that there’s no exercise that somebody shouldn’t do or should do is very difficult. And in general, you’re probably going to end up having to have a bit of an individualised exercise programme to make it most effective. That said, there’s always an exercise programme that we can have someone do what the biggest problem with exercise is learning how to titrate it, and how to do it at a level that doesn’t make your pain worse, but also makes it better.
For some people with chronic pain, activity increases their pain and what we want and expect that there may be some level of increase, but it shouldn’t be long lasting. So after the end of an exercise programme if you still have pain for 30 minutes to an hour afterwards that’s increased from before. Maybe that’s okay. But if your pain is still there, three or four hours or the next day, maybe we need to reduce the intensity or change the programme a little bit. So good. So obviously getting together with someone who’s specialises in chronic pain and exercise would help you to learn the skills to be able to balance the amount of activity you do with the amount of pain and your response to the exercise itself, to have the most effective outcome.
And in those cases, when pain is heightened for hours after exercise, and the intensity may need to be reduced. Does it have to stay reduced? Or does it sort of then you can grade up and increase?
Yeah, exactly. I think you can probably, you probably just overdid it one day, and you need to bring it back down. And maybe you need to just go up a little bit more slowly, the next time take it up a smaller increase than you did the first time. But yeah, you can, I think what happens is people feel really good, and you’re having a great day, and there’s all this stuff I want to do, because I haven’t been able to do it for a week or two or a month. And now I’m available, I’m gonna go do that gardening I wanted to do, I got to get the laundry done, I got to clean the house. And then you do it all in one day, and you have just quadrupled or gotten up 10 fold how much activity you do on a day to day basis, and you’ve overdone it. So learning how to titrate it and how to go up on a slow when you’re having a good day not to overdo it. And when you’re having a bad day that it’s okay to occasionally take a day off. The goal is not to take a week off. You know, you don’t have to exercise every day, maybe every other day is good enough if you can commit to three to four times a week. So things about, you know, the design and the plan is really important. It doesn’t have to be daily. It doesn’t have to be high intensity, it has to be regular. And it doesn’t matter what you do as long as you do it. So whether you want to do yoga, you want to do Tai Chi, you want to walk around the block, or you want to run, or you want to go to the gym and do some strength training. Oh, that’s fine, is what you will do.
But again, my number one most important thing about exercise is that it changes the system. And it reverts it back to normal across multiple multiple systems. And that is just so cool that it’s working across all these different pathways. In the medical world, if you were going to give a drug you’d have to give 10 drugs to do what exercise does with just the activity alone.
That’s fantastic. Thanks so much for chatting with us.
Absolutely. Thank you for having me.