Exercise - The Daily Warrior of Pain Control.

You may be in recovery from surgery, radiation, or other oncology treatments that have caused any combination of of the following: constipation, diarrhea, nausea, postoperative pain, pulled muscles, spasms, twinges, fascial restriction and scar adhesions, numbness, itching, burning, skin irritation and rashes. Or you may have chronic pain that takes the form of joint pain, neuropathic pain, pain from inflammatory conditions such as IBD and IBS, or pain from migraines. Further, there may be an assortment of prescription pain medicine choices to make which are intended for short term use to reduce your pain level. These may even be necessary to allow for inflammation to subside and healing to begin. There are many different types of pain and pain control prescriptions; it is important to know which are opioids.

According to the American Academy of Pain Medicine, opioid prescribing in the USA needs a lot more training in ethics and patient-centered compassionate care management. 1 in 10 americans use some form of prescription painkiller. Careful prescribing behaviour by physicians is required in order to prevent addiction based drug seeking behaviour. If you find yourself or you know of someone needing help with any controlled substance abuse, speak honestly and openly about it. Contact the physician prescriber about your concerns and to find a solution together. If that is not an option, help is available via these links.

With pain, there is often one overlooked, highly effective form of treatment for pain control: Exercise. Exercise consists of strengthening, stretching and cardiovascular exercise. The high-level explanation for how exercise can help pain reduction is via the endorphins generated. These endorphins can also cause a reduction in anxiety and depression, improve memory, and improve sleep quality.

- Cardiovascular activity can be done in the form of swimming, running, jogging, cycling, walking, racquet sports, or team sports participation (think ping pong, not rowing or football).

- Strengthening can be done using your own body weight (yoga, pilates), or a water bottle, a few books in a backpack, or a couple cans of soup depending on your current muscle mass.

- Stretching needs a mat or a cushion or a chair depending on your ability.

Exercise is in itself a form of medicine because of its drug-like effects on the body, and could be habit-forming to the benefit of your health and longevity overall. Further, you don't have to be working out at ironman fitness levels to gain benefits. You need to do regular, low intensity exercise to start. Every type of exercise you do on one day will help you to become stronger for the exercise you do the next day. It will build your endurance and strength and best of all, it will reduce your pain.

When it comes to pain we are all individuals, and our bodies process the medications very differently. Of course, on the three-page list of pain control medications I was offered, the pharmacy was sure to indicate which ones they preferred me to take over the opioid based options. I didn't want any opioids at all. But I was definitely not a martyr after my surgery and didn't tolerate my pain without some medication. I had a lot of left sided back pain that came up. I took 500mg Tylenol every 6 then 8 hours for the first two weeks and moved to Ibuprofen after that, taking 400mg every 12 hours. I took one Robaxin to help with breakthrough pain at night only in the first 10 days then stopped because I needed to drive the following week. I brought all of these back to a pharmacy that accepts medication for proper disposal when I was finished with them at about 3-4 weeks after surgery. My left sided back pain was manageable with stretching by then, and went away after about 6 weeks in total. Some additional strategies I employed are listed below, and I encourage you to build upon these for what works for you. I did not do all of these every day nor start these when I got home from surgery. I do not expect that you do all of these every day.

Just pick one and start when you are given the go-ahead by your doctor to exercise. Always check with your doctor if you have any questions about how to start. Ask for a referral to occupational or physical therapy if you have trouble with balance or mobility to help you get started. Make sure your medications are checked by a pharmacist for any interactions that could affect your ability to exercise. If your pain goes up after exercise understand that it means you do not have to stop entirely but you may need to reduce the time or intensity to better match what you can tolerate.

  1. Walking. I mainly did this so I am listing it first, in greater detail. In the first week home, it looked like this: Me walking around the house for a minute. That's all folks. I had to sit down and stretch for that weird back pain I had. I walked slowly and did a few laps around the kitchen table and the sofa to start. Then on the third week home, I went walking to the mailbox (about a 2 minute walk there and back) to get the mail. My first try I stopped part of the way and had to stretch my back and turn around and go back home. I tried to do too much too soon and my pain levels went up a few days after. I revised my goal about that mailbox, and more carefully brought my walking duration eventually to 15 minutes, making sure I had good form when I was walking - no weird steps or imbalance in my gait, no bending over etc - to ensure I was using all the muscles needed for walking. It was slow but steady progress, guided by my pain levels. Some days were definitely better than others. As I tolerated walking I would set longer goals. I would aim for 30 minutes/day and find myself in pain at 20 minutes. I would call a friend or a family member (we were in a pandemic so I did not have a walking buddy) to chat and help distract me from the discomfort and get me through that last 10 minutes back home. It worked for me. Then I would stretch (see below).

  2. Squats - I did standing squats, holding the back of a chair for balance, for a minute, then two. Up and down I would bend my knees, keeping the three curves of my spine in their correct posture, focusing on bending at my hips. I did these and the reverse lunges after meals. I did them when I could and certainly did not do them every day either.

  3. Yoga - 15 minutes to start with a beginner yoga on YouTube worked for me to build back some core strength and practise some breathwork in addition to that incentive spirometer. Once I got the routine down, I would do these on my own as a break after sitting/working too long or before bed to help relax.

  4. Reverse Lunges -We all have these days - when it was a non-motivational day (feeling sorry for myself, raining, or too hot, or walking felt boring), I would change things up and do reverse lunges: a big step back with one leg, followed by a knee bend from the front leg down and then up. I would switch legs and aim for 10 on each side, then 15 on the next set, and whatever was possible on the third set. And I did these very slowly. By then I was out of breath, but it was a good 10 minutes of effort. I usually did those after eating, followed by the stretches below.

  5. Stretching: Deconditioning, or losing one's muscle mass and fitness levels, is a major contributor to chronic pain. Stretching gave me an idea of how tight my muscles got since surgery. I was only able to stretch on the floor at 3-4 weeks post-op.

  6. Weight lifting - for me this was lugging my water bottle around on my walks once I got to walking outside. It was a 32-ounce bottle weighing 2.6 pounds when filled. I would do my bicep curls and tricep raises. It was about 2 minutes per arm for each exercise, repeated 3 times. Then I could drink the water when finished while I was still out walking and stay hydrated too. Your version could be wearing a backpack with 10% of your body weight inside in the form of soup cans or books or hand weights and walking. When I am cleared to lift more weight, I will return to pushups and other lifting I did before surgery, like lifting our 5 year old daughter up for a hug, and carrying my garden watering can around the grass to my potted plants.

If the above options sound like something you can do, please feel free to start with one or all of these and build upon them. Go slowly and with intention. Celebrate each workout completed with some reinforcing positive thoughts about how you a) tried b) did well and c) that you can do it again tomorrow. Celebrate by telling others about your progress so they can celebrate with you. Celebrate in meaningful ways that reward your effort and keep you motivated.

If the above options to reduce your pain sound less than motivational, I have listed others for you below. Pain medication is most often meant to be a short term option to encourage healing while maintaining mobility and function. Set a goal to be a daily warrior, not a weekend warrior, to get you out of the pain you feel. It is the daily workout that makes the progress over time to being pain free.

1. https://www.healthline.com/health/exercises-to-reduce-chronic-pain#Strengthening-exercises-

2. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/other-activities/two-minute-exercises-for-pain-relief

3. https://www.onhealth.com/content/1/exercises_low_back_pain

4. https://www.huffpost.com/entry/the-5-best-exercises-for-chronic-pain_b_575630e8e4b0c252dce9e15e

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