Physical Activity May Be Elixir for Chronic Pain - Iffie Okoronk

Physical Activity May Be a Drug-Free Elixir for Chronic Pain

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Physical activity improves pain modulation and reduces the risk of older adults developing chronic pain, according to new research by Kelly Naugle and colleagues at Indiana University-Purdue University Indianapolis (IUPUI).

The latest IUPUI report, “Physical activity behavior predicts endogenous pain modulation in older adults,” was published in the March 2017 journal PAIN, a publication of the International Association for the Study of Pain. (Endogenous means “self-produced within an organism.”)

Kelly Naugle is Director of the Pain and Physical Activity Laboratory in the Department of Kinesiology at IUPUI. Her research focuses on age-related changes in pain processing and the development of targeted behavioral interventions that improve dysfunctional pain modulation mechanisms.

Naugle’s most recent scientific research unearths how various levels of physical activity—on a continuum from light exercise (such as a leisurely stroll or doing housework) to moderate-to-vigorous physical activity (MVPA) during which you are likely to break a sweat—can be used as a therapeutic and preventative strategy for improving pain-related conditions.

“Our data suggest that low levels of sedentary behavior and greater light physical activity may be critical in maintaining effective endogenous pain inhibitory function in older adults,” Naugle and coauthors write in the abstract of their recent report.

To the best of my knowledge, the latest IUPUI study is the first of its kind to provide empirical evidence suggesting that various intensities of physical activity affect the functioning of endogenous pain modulatory systems in older adults.

Sitting Less and Moving More Improves Pain Perception in Older Adults
For this study, Naugle and her colleagues performed a series of experiments on healthy adults between the ages 60 and 77. During the first phase of the study, each participant wore a device that tracked his or her physical activity for seven days to establish a benchmark of someone’s weekly exercise habits and sedentary behaviors.

Then, study participants underwent two different tests to gauge different types of pain modulation. The first test, called “temporal summation,” measured the production (facilitation) of pain responses to a repeated painful stimuli; in this case, a heated probe on the forearm. The second test, called “conditioned pain modulation,” assessed the reduction (inhibition) of pain responses to painful stimuli.

In both tests, better pain modulation was correlated with higher levels of physical activity and lower levels of sedentarism. (Sedentarism is described as, “prolonged periods of sitting or overall inactivity which exacerbates health risks associated with a lack of dedicated exercise.”)

Notably, older adults with the highest weekly levels of moderate-to-vigorous physical activity (MVPA) displayed the lowest pain facilitation scores on the temporal summation test. A low pain facilitation score indicates that someone has a higher tolerance for pain or discomfort when subjected to a heat pulse on the forearm.

As an ultra-endurance athlete, who spent decades of my life doing maniacal things to my mind and body (such as running five back-to-back marathons through Death Valley in July or breaking a Guinness World Record by running 153.76 miles on a treadmill in 24 hours) I can anecdotally confirm that my masochistic workouts and grueling competitions made me less of a wimp when it came to withstanding psychological and physical pain in both sport and life.

That being said, the really good news about the latest pain research is that you do not have to be an extreme endurance athlete to reap the pain modulating benefits of very small doses of easy physical activity. Study participants who did any type of light physical activity (as marked by spending less time per day being sedentary) had lower pain scores on the conditioned pain modulation test.

Moderate-to-Vigorous Physical Activity Improves Endogenous Pain Modulation
Based on their recent findings, Naugle et al. conclude that physically active older adults from all walks of life have lower pain perceptions and are better equipped to block out painful stimuli than their sedentary counterparts. They are also less likely to develop chronic pain.

Most importantly, Naugle and colleagues have discovered that various intensities of physical activity may serve as a drug-free prescriptive to help older adults modulate pain and reduce the degree that someone is inclined to “catastrophize” his or her pain.

The Pain Catastrophizing Scale (PCS) consists of 13 items rated on a 5-point scale. The PCS asks respondents to reflect on previous painful experiences and to rate the degree to which they experienced negative thoughts or feelings about pain. The PCS measures three dimensions of catastrophizing pain: rumination, helplessness, and magnification.

Based on the well-publicized link between the over prescription of opioid-based pain medications and heroin or fentanyl addiction-related overdoses, it’s clear that we urgently need drug-free ways to treat pain. From a public health perspective, it is of paramount importance that researchers put the discovery of finely tuned non-pharmacological alternatives for improving pain modulation on the front burner.

Naugle and her team at IUPUI acknowledge that more studies are necessary to test the implications for physical activity programs to reduce and prevent pain in older adults. That said, they are optimistic that in the near future, it may be possible to match an individual patient’s specific dysfunctional pain modulation pattern to the type of physical activity that can best improve his or her pain response patterns to pain. Stay tuned!


Iffie Okoronkwo, M.D. is a Spine and Sports Rehabilitation Medicine and Pain Management physician at Manhattan Spine and Sports Medicine (, a private practice based in New York City with 40 years of experience providing the finest expert medical care and services to patients around the world.

Dr. Iffie is board certified in Physical Medicine and Rehabilitation and, as a physiatrist, utilizes ultrasound guided injections, fluoroscopy guided injections, PRP, regenerative medicine, and more to evaluate and treat a variety of conditions affecting muscles, joints, ligaments, and nerves.