Listen Well

Breaking the cycle of chronic pain and depression

Episode Summary

What is the purpose of pain? And what if the pain we feel doesn’t have a purpose anymore?

Episode Notes

What is the purpose of pain? And what if the pain we feel doesn’t have a purpose anymore?

In this episode, we’ll be getting a bit uncomfortable as we try to comprehend what it’s like living with chronic pain. Join us as we explore the commonalities and linkages between chronic pain and depression to help understand why these two conditions commonly coexist.

We’re joined by Dr. Ernest Choy – Professor of Rheumatology at Cardiff University – as well as Rebecca Gillett and Julie Eller, hosts of the Arthritis Foundation’s “Live Yes with Arthritis” podcast, to hear about their personal experiences with chronic pain and mental health.

The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris.

Arthritis Foundation (USA): https://www.arthritis.org/

Live Yes! with Arthritis Podcast: https://liveyeswitharthritis.fireside.fm/

Episode Transcription

Disclaimer: 
This podcast is provided for educational purposes and is not intended to replace discussions with your healthcare provider. All decisions regarding your care must be made with a healthcare professional, considering the unique characteristics of your personal situation. The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris. Individuals featured in this podcast may have participated in the past or may be current members of an advisory group for Viatris.

Dr. Alsuwaidan:  

Hello and welcome to Listen Well. Where we connect you to the world of health and wellness. I'm Dr. Mo Alsuwaidan. Today on the podcast, we'll be getting a bit uncomfortable, as we try to comprehend what it's like living with chronic pain. Particularly, we want to explore the commonalities and linkages between chronic pain and another potentially disabling diagnosis, depression.  

Why did these two conditions seem to commonly coexist? Does it solely have to do with the mood that pain induces? Or does it have to do with common pathways between depression and pain, within our bodies? To help us answer some of these questions, we'll be speaking with Dr. Ernest Choy, Professor of Rheumatology at Cardiff university. As well, Rebecca Gillett and Julie Eller, hosts of the Arthritis Foundation's Live Yes! With Arthritis podcast, to hear about their personal experiences with chronic pain and mental health. We invite you to join us as we learn about how pain becomes chronic, the vicious cycle of pain and depression, and what you can do to break it either for yourself, or for someone you love. It's time, to listen well.

PART 1: where Pain comes from & Chronic pain

a question in my mind is, what is the purpose of pain in the first place?

Dr. Choy:

Okay, well pain is fundamental to survival, if you like. In high mammals, high animals, pain is important for them to protect themselves, because naturally we are prone to injury, and pain stops us after injury produced more damage to the joint or tissue.

Dr. Alsuwaidan:  

So it's a way to protect yourselves?

Dr. Choy:

Absolutely. Absolutely. And in fact, we know diseases associated with inability to feel pain causes excessive structural damage. And as a rheumatologist, the core specific condition called Charcot joint in patients with diabetes, when they lose local sensation, then their joints are subjected to excessive injury and excessive damage.

Dr. Alsuwaidan:  

Because they're basically not feeling it.

Dr. Choy:

Exactly. So when you don't feel pain, you won’t stop doing what you're doing. So you cause damage.

 

Narration: A little aside, here. Just want to make a quick distinction for you between two types of pain – acute and chronic. Trust me, this is important. Acute pain, which can be mild, moderate, or severe, is pain that lasts for just a moment, or for weeks or perhaps at most a couple of months, resolving on its own. Chronic pain refers to pain that is ongoing and is usually defined as lasting 3 months or more.  

Dr. Alsuwaidan:  

what happens with people who have chronic pain? What's the difference between chronic pain and pain you feel on a day to day basis?

Dr. Choy:

Well, one of the fundamental differences, as I said, is that how pain started. Because it's there to designed to protect us from damage. The whole evolutionary process is about dealing with pain that develop acutely due to injury.

Dr. Choy:

Now, if you think about an animal living in the wild, when they have an acute injury, they can rest, but it's highly likely that that individual or animal cannot survive because injury caused you to be painful and you have to rest. It means that you can't hunt or escape from a predator.

Dr. Choy:

So naturally, in animals that suffer from pain are less likely to survive. So I think in the wild, not many animals will survive with chronic pain. The difference between us and in the animal kingdom is that we can survive chronic pain, but the problem is that our biology may not be adapted to having chronic pain.

Dr. Alsuwaidan:  

Are there different ways to conceptualize pain?

Dr. Choy:

Pain is a very complicated experience. It is very different from touch. So when we all experience touch and our brain tells us where the sensation is coming from and how bad that magnitude is, but that's in the main what touch indicates.

Dr. Choy:

In pain, what is clear is that when we experience pain, our brain not only just sends the pain telling us how big that impact is. It locates the pain in the somatosensory cortex in the brain. So it tells us where the pain is coming from, but immediately other parts of the brain become activated; brain areas that is involved with dealing with stress become activated. There are areas in the brain that deal with emotion become activated, and there are areas of the brain that involving thinking become activated.

Dr. Choy:

Pain is always interpreted as something that is very unpleasant, you want to avoid it. And so that speaks to the emotional elements to pain. And I usually give this example to my students, I said that every day when a baby is born, a nurse would inject vitamin K to the baby.

Dr. Choy:

And I used to ask them, how do you know the baby experienced pain? how do you know the baby doesn't actually cry out and say that I am in pain. But you all said that the baby's in pain.

Dr. Choy:

And of course they counted that up to them, is that they interpret the baby in pain because the reaction of the baby is to cry. And I pointed out that crying is an emotive response. So actually we link the emotional element to someone experiencing pain. There's no difference from someone walking through a casualty with an injury. You gauge how bad the pain is by looking at whether the individual was crying and become emotional too. Actually, it makes sense.

Dr. Alsuwaidan:  

That's fascinating, the way you describe it, because I think most people when they think about pain, they're just thinking of the feeling. But you're right, there is this whole emotional response around it, and it's a whole experience.  

 

Narration: Now, as I mentioned in the intro, I had a chance to chat with two inspiring women who work with the Arthritis Foundation. Both have experiences with the challenges of pain from relatively early on in their lives. Their stories will help illuminate the links between pain and emotion, among other insights. Here’s Julie’s story.  

PART 2: Personal stories

Julie:

I was seven years old when I became symptomatic with juvenile idiopathic arthritis, but it took years before I was able to actually receive that diagnosis. I was about 10 by the time we really figured out what was going on. So much of that story has to do with growing pains. For the folks in the juvenile arthritis community, It can be really difficult to identify that the symptoms that a child is experiencing are atypical to traditional growing pains when your body is changing so much over a course of a short time. When I was a child, I got this pair of pink Barbie sparkly rollerblades. I was seven years old. I got it for my birthday and I was so excited by them and I remember I took them out of the box and I was just thrilled to have them  

I rode them around my neighbors’ driveway, which was very flat and I took them off my feet because my ankle started to ache, really ache. I was seven years old. I didn't really have language to describe what had happened other than ow this really hurts. I took my roller blades inside and I talked to my mom. As moms do, they look and they kiss and they give all the love that they can and then they say, let's go talk to a doctor.

We went to the ER to see, you know, did I break my ankle? Did I roll it? Did I twist it? Despite all of my protest saying that none of those things had happened, I had twirled in perfect rollerblade circles. I had made no mistakes. We had to go to the doctor anyway. When we had x-rays and I had some substantial swelling in my left ankle and I had some murky looking x-ray photos. They weren't quite familiar with what was going on or what was happening, but they thought maybe she has a hairline break.

Julie:

I replaced my rollerblades with this purple plaster cast for quite a while. I think I was in it for about six weeks. When they sawed it off, they realized that my ankle was just as swollen as it had been initially and they really weren't sure why. They put me in an air cast for quite a while and I found myself toddling around in my air cast.

I used crutches for a while and at my worst points I required ambulatory wheelchair to get around school and eventually we had seen a whole lot of doctors with very few answers. I think by the end of my diagnosis journey, those two and a half years, we had seen about 17 providers all with different information until we found the one who looked at me, who looked at my blood work, who looked at my x-rays, who felt my joints and said, "Oh, textbook. This is juvenile idiopathic arthritis."

 

Narration: Juvenile idiopathic arthritis (JIA), is any arthritis of unknown origin that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. It affects up to 1 in 2,000 children worldwide.  

Julie:

But then when I was paired with the right person who could offer those things, we were able to get on the right treatment. I was able to really start to feel much better, much more consistently able to return to some of the hobbies that I had loved before I became symptomatic. I got to do some more dance and some more soccer eventually and someday I got to perform in plays and do all of those things that I had loved before diagnosis.

Julie:

But all that was only possible because of really good access to medications, and physicians, and advice, and physical therapy and occupational therapy. That really got me there.  

Narration: Rebecca’s journey started later than Julie’s, but still quite early on in her adult life. Like many people who have new pain and see a doctor, Rebecca was initially told that her pain must be due to an injury, which may often be true, but not always...

Rebecca Gillett:

At the age of 26 I was working in marketing and doing really well in my career and recently had purchased my first home at the age of 24. And was doing really well for somebody in their mid-twenties.

One day I woke up and my wrist hurt and I thought, well, this is weird. I don't remember falling or tweaking it or doing anything to injure myself. I don't know why it hurts and it hurt so much that I actually did call my primary care physician and went to go in to see him to figure out what was going on. He wrote it off as, oh, you probably just sprained it. There's all kinds of stuff you could have done to sprain it to make it hurt. Go take some Ibuprofen.

Ice it rest it and get one of those braces over the counter and come back and see me if the pain isn't better. Well two weeks went by and I woke up one morning to get ready for my job and I couldn't move. I couldn't really get out of bed. I managed to get to the shower, but I couldn't even raise my shoulders to be able to wash my hair.

Rebecca Gillett:

Had a very difficult time getting dressed and it took me well over an hour that morning to struggle through that pain. Had no idea what was going on. By the time I finally made it into my car, I did have to call work and say, "Hey, I'm running late. I don't know what's happening. I don't feel good. I'm in a lot of pain." I get to my car and I go to try to start my car.

At the time it was a manual car and I couldn't put my car in reverse. I couldn't move my shoulders enough to get my car to reverse out of my driveway and so turn off the car and I sat there and I cried. I had no idea what was happening to me. Of course, who do you call when you're in that kind of pain? I called my mom.

My mom was worried right off the bat. My mom has lupus and she had been through a diagnosis journey herself and so right away she said, you need to call your doctor back. Tell him to check you for rheumatoid arthritis, to check your sed rate, to check your inflammation markers and see if that's what's happening. I was confused because I was like, well, how do you know about that? What's rheumatoid arthritis?

I'm only in my twenties I shouldn't have a disease like that. But sure enough, I got into my doctor right away and my labs showed that I was already at a moderate to severe phase of rheumatoid arthritis.  

 

Narration: For those of you who don’t know, rheumatoid arthritis is one of many forms of arthritis, and is a common inflammatory disorder where the immune system mistakenly attacks healthy tissue in the body.  

Rebecca Gillett:

I already had a lot of deterioration happening and much different diagnosis journey then some people. It can take up to two years or three years to get a real diagnosis. But only because my mother was educated in rheumatic diseases because she lives with one. She had RA ruled out when she was first going through her journey. She knew exactly what I needed to ask my doctor and the questions I needed to ask and the labs I needed done.

And so I did get a diagnosis within one month of that initial pain and went to my rheumatologist and he tried to start treating me aggressively right off the bat. It took a couple of years of dealing with flares and constant pain before I really learned that there were some things I could do to take control. That's what led me to realize, hey, I need to go out there and help other people like me because I feel like somebody should have taught me the things that I wish I had learned two years into my diagnosis right when I was diagnosed.

In the middle of graduate school one semester away from graduating with my masters as an occupational therapist, I was having incredible pain in my neck and spine and shoulders and found out I had degenerative disc disease and osteoarthritis in my spine.

That required me to have a fusion of my neck in the middle of OT school. So it was quite a journey even though the initial diagnosis I had at 26 was rheumatoid arthritis. Rebecca:

My joke is always that I live in an 80-year-old body. And actually, my first cervical spinal fusion, my neurosurgeon did say to me, I was 31 at the time, he was like, "Your spine looks like that of an 80-year-old woman. What did you do?" And I'm like, "I didn't do anything. I don't know what you mean, I don't know why it's that bad,” right?  So I can see how limiting it can be when you are in that pain, and how other people can't see your pain. It's invisible, right? They don't know that it's hard for me to bend over and do something, or turn and twist my back to do an activity or do some of the things that I used to do.

 

Narration: So we’ve journeyed from two painful and limiting rheumatic diseases to osteoarthritis, another painful and limiting condition that – according to estimates from 2017 – affects over 300 million people worldwide. That number will likely grow in the coming years. For decades, osteoarthritis was thought of as something that just happens to people as they get older. But we now know that osteoarthritis is a complex, progressive, debilitating disease of the joints, causing pain, swelling, trouble with sleep and difficulty carrying out daily activities that severely reduces the quality of someone’s life as well as their independence. We also know that osteoarthritis can have a real impact onmental health. I circled back to Dr. Choy with some new questions about Osteoarthritis and emotional health.  

 

PART 3: OSTEOARTHRITIS & Treatment

Dr. Choy:

So osteoarthritis is one of the common conditions in the world, and as we get older we are more prone to getting osteoarthritis. And in the past we kinda think of osteoarthritis as a disease of aging and degeneration. But nowadays we know that osteoarthritis have many different types, and in fact in some individuals they have more pain than others, if you like.

Dr. Choy:

And the level of pain is not always related to the level of damage we see on x-ray. We know that for a long, long time, and although the pain is located in the knee, what we understand is that the severity of the symptoms is a lot more than due to the damage. It is related in part to how much inflammation they have in the joint, and how the brain process that impulse from the joint, but it also dependent on how good the person is able to cope with their pain. And this is a very important concept, because osteoarthritis is a chronic condition, so they have chronic pain coming from the diseased joint. But how we cope with the pain actually determines of how we perceive the severity of that illness.

Dr. Alsuwaidan:  

So what does a person with osteoarthritis feel other than pain? Do they have other symptoms that are common?

Dr. Choy:

Well, first of all, in osteoarthritis, many patients, especially with what we call significant chronic pain, they often get very emotional. There's a lot of research to show that the level of pain in this individual is related to the mental state. Anxiety, depression seems to be more common in these individuals, and in the past we kind of dismissed that. We think that these are just individual with concomitant mental conditions, and that's why they are more anxious and they're way more depressed.

Dr. Choy:

But based on what I explained earlier, the fact that the pain experience is fundamentally linked to emotion, what the linkage seems to be is that pain will, in general, generate an emotiveresponse. If you are in the state to control those emotions, then the pain don't limit as much as what you can do. But if you have a state in which you cannot relieve the pain, so the pain becomes chronic and severe, it tends to be to a more severe emotional response to it. And that's why depression and anxiety is more common in people with severe chronic pain.

Dr. Alsuwaidan:  

And I'm sure you see a lot of people with osteoarthritis. What does it stop them from achieving?

Dr. Choy:

Well, pain is the most limiting factor in these individuals, and in part it stems from the biology that I explained, because one of the initial key functions of pain is to stop you doing things. We interpret pain as a threat, so we stop doing what we are doing in order to avoid pain, and that is instinctive to us and to the pain experience, and we don't have to learn to do that. We always do that by reflex.

The problem is that when we have chronic uncontrolled pain, we need to have a process in which we need to get on top and control the pain processing. Now, I mentioned before in the recent research, we know that there are parts of the brain which is in control of how to manage the pain processes, what we call the cognitive part of the brain. And I think in certain individuals, this part of the brain is not working as well.

So we can't control the pain as well. And actually, a simple example of why this control of pain is important can be illustrated from what we do every day in hospitals. We ask for patients to go for a blood test. We know that the needle will be painful, but we don't retract our arms when the needle pokes through the skin, and that's because the brain tells us that, to expect a certain level of pain, and to assist and cope with the pain. But that is an acute pain episode. When the pain becomes chronic, the tasks becomes a lot more difficult.

 

Narration: Remember, acute pain tends to resolve in the short to short term, while chronic pain is much more long lasting.  

Dr. Alsuwaidan:

So speaking of management, how would you break down their approach to managing someone with osteoarthritis?

Dr. Choy:

So in general we break down management of pain to those that are non-pharmacological, so non-medicine related. And then those that involve medications. So there are generic things that we can do to help pain. We know that actually exercise is quite helpful, because recently we have learned that exercise helps to activate regions of the brain that help us to cope with pain. So exercise is important for most people with chronic pain, and we know that if the patient is overweight they can ... By weight reduction they can reduce the pain amplification process and reduce inflammation, and that can be helpful.

Dr. Choy:

There are lifestyle advices in general, like stopping smoking, being generally healthy, having the right diet and that can supplement the management of a chronic illness process. Having a good quality sleep is very, very important in the management of pain, we shouldn't forget that. And then in terms of medication, we are starting to classify painkillers into different types to help with the different aspects of pain, and in fact we now recognize that helping the patient's mental health and emotive state, with certain medication and improving their sleep quality can also help with the management of chronic pain. Aside from the usual analgesics and anti-inflammatory tablets, especially for osteoarthritis.

 

Narration: Now, as we explored earlier with Julie and Rebecca, as well as with Dr. Choy, pain and mental health are closely linked. But that link is more obvious when we are dealing with chronic pain, as we see in chronic conditions like arthritis – and it can be a two-way street.  

Part 4: Link with Mental health  

 

Dr. Alsuwaidan:  

One of the things that you mentioned earlier was depression. So what is the impact of depression on osteoarthritis?

Dr. Choy:

Well, depression has what we call a bi-directional impact. In patients with osteoarthritis and chronic pain, I've mentioned earlier, that the emotional element is a fundamental part of the pain process. So if pain is not relieved, it makes us depressed, it makes us agitated, stressed and anxious. That is part of the effect of pain. When you have depression, one of the commonest symptoms associated with depression is actually poor sleep quality. So even actually when people's [inaudible] are better, they become more... They still struggle to have a good night's sleep. And recent research has shown that having a good quality sleep is really important in activating parts of the brain that are involved in controlling pain. So if we just take some healthy individuals and we disturb them during their normal sleep cycle, stop them from sleep through the night, what we find is that after a few days, then they become more emotive. And when they become more emotive, they also are unable to cope with pain. And many of them actually develop muscle ache as a result of poor sleep quality.

So the problem in many cases, in our patient with osteoarthritis, is that they have chronic pain as a result of the disease. They then become emotive and if they become finally depressed or have pre-existing depression, they have less ability to control and cope with the pain.

 

Narration: Rebecca and Julie know all about this relationship first-hand.  

Rebecca Gillett:

Yeah, definitely. I think that when you first get a diagnosis, it's really alarming. You start really ... We talk about this in one of our podcasts actually on wellness and mental health. And we talk about how you kind of go through stages of grief. Silently, oftentimes people go through that because they don't have the words to name it. I would say when I was diagnosed at 26, I was in denial for quite a while and didn't seek out information and resources. Just figured oh well,

Rebecca:

I'm young, I'll get over this, right? And until I really had a talk with my doctor and he said, you know, "What is your anxiety level? What is your stress? How are you feeling?" And I said, "Well, you know, there's nothing I can do, right? I'm just going to have to live with this so I'm just going to keep plugging away." And he tried to really educate me on the fact that you know, "Not taking control is harming you more. That's why we can't get your disease under control." But also "If you can reduce the stress and anxiety that you're feeling right now, we might be able to reduce some of your chronic pain." And I never really put two and two together. So he kept trying to get me to take anxiety medication to show me that "If we can reduce some of these feelings that you're having of anxiety and stress, we might be able to reduce your pain." And begrudgingly, I did it. I went on medication, didn't want to take it because of all the stigma around, well, for one, being on medication for my mental health. But also for the concerns of gaining weight. But he was right. After two months of being on some medication, I realized that, "Oh, this is actually helping with my pain." We were able to get my disease under control a little bit, especially since we started finding a combination of medication that worked for me. And it’s been tough,  

Rebecca:

It's a journey that I don't wish upon anyone, and I understand how hard it is to deal with pain on a daily basis. But then I also understand how hard it can be to decide, "Well, do I want to go through with a surgery? Is it going to be worth it?" But there's a lot of anxiety around having to do that. So it's almost a vicious cycle really.  

Julie:

Rebecca, I really love what you said about the stages of grief being stages that you go through again and again and again. I think with arthritis, your care really waxes and wanes based on whether you're in a flare, or maybe you're having some feelings of remission, or you're just managing well. And that has certainly been true for me. And as my physical joint health waxes and wanes, I find that my mental health does the same thing in harmony with my joints. Or maybe disharmony with my joints. And those were the toughest days. Those are the toughest days, when my joints are flaring and angry, snapping, crackling and popping, and my brain fires up as well. My anxiety skyrockets, and my feelings of numbness kind of return when it comes to my emotional health.

Julie:

And those are the times that it's really important to leverage a network that is broader than just you, or just you and a caregiver, or just you and to caregiver and your rheumatologist. Those are the moments that I think are really essential to pursuing some help from a mental health professional. And whenever I was a teenager, because I grew up with arthritis, I've known it that long. So whenever I was a teenager, I remember sitting in a health class and learning about the classic signs and symptoms of depression, and sitting there taking notes in my notebook, trying to remember all the things I would need for the upcoming test and wanting to ace it and do all of these things.

Julie:

And as I wrote down the symptoms for depression,

Julie:

And I realized in that moment, as I was looking at that notebook and thinking about my health, "Well, hey, I think that I have this too. I think that I struggle with anxiety." And that moment of seeing it and believing it triggered me going and pursuing help from a social worker who was trained in kind of mental health therapy and providing those resources. And within three months of meeting with her consistently, I got in control again. And I was in control for quite a long time, and I had years of being in control. And then another flare might crop up later on that encouraged me to go through that cycle again.

Narration: Persistent feelings of low mood, anxiety, difficulty sleeping or not enjoying the things you once did may be signs of depression or anxiety disorder. Mention these symptoms to your doctor who may be able to help.  

Rebecca:

Your family, your loved ones, and what you're going through can have such a great effect on the people around you. And how you manage it, how you share that, and whether you communicate well about that or not. And that takes time. That's a process to really try to get better at doing is sharing and communicating how you're feeling with others so that you can get the help that you need, whether it's physical or mental, you know. I'm stubborn, so I hate asking for help, but my husband knows me well enough to know that now, "Nope, nope. This isn't something you should do." And he has to reel me in sometimes back to reality, like "That's not the best idea for you. You're going to hurt tomorrow, so let's not do that."

 

Narration: Of course, knowing your limits is good for anyone, but especially for those with painful conditions, it’s essential. But pushing physical limits, within reason, is also essential for physical and mental fitness. It’s a fine balance – and we explored it with Dr. Choy.  

PART 5: Exercise and pain  

With exercise, what is it actually doing in the body? How does it help with osteoarthritis?

Dr. Choy:

So actually recently we understand that exercise and pain have a direct relationship and we learned that not so much in our patients with osteoarthritis, but healthy individuals.

Dr. Choy:

So we know that long distance endurance athletes are actually able to control pain. The commonest example is marathon runners. So when you start to exercise, you start to get aching sensation in the muscles. But most people will know that if they press on and carry on to exercise, that aching goes. And that allows a long distance runner to carry on exercise for a much, much longer period.

Dr. Choy:

So exercise actually helps to train our brain to cope and manage with pain. So the issue I think sometimes in our individual patients who don't exercise is that gradually they lose the ability to cope with pain. So exercise is not just about helping us to strengthen our muscles and bones, although that is important on its own, if we stop exercising, gradually we lose the ability to cope with the pain.

Dr. Choy:

So controlling pain involving doing exercise. Now the issue for most of our patients, when we talk to them about exercise, is that there's a general fear about exercise, because they know that initially when they start to exercise their joints or muscle would become more painful. And the key for us to teach our patient is that in fact what we need to do is to warn them that that will happen initially. Just as we would expect that we will get pain when we go to the gym, as normal individuals.

Dr. Choy:

But actually over time our ability to cope with the pain improve with exercise. The key is to exercise gradually, not to go what we call a boom-and-bust scenario. It's not about doing lots and lots of exercise in one go to make the pain unbearable. It is to understand at what level of exercise we should do we will get some pain, and gradually build up our tolerance to the pain. Because in fact, our ability to cope with the pain and activate the descending inhibitory pathway, require us to get some level of pain first. So the level of exercise that one do is individualized. So some people can start off with doing fairly normal exercise. They can walk, they can go swimming, but other individuals, particularly those who have become what we call deconditioned, haven't exercised for a long time, they need to do it more gradually. But what I find with most people is that it is very rare for people to lose the complete ability to exercise.  

 

Narration: Ok, so why am I getting the feeling he’s talking directly to me right now. I’m trying not to take this personally, and neither should you.  

Dr. Choy:

Even in the individuals who are most averted to exercise, often I recommend them to start with very mild form of exercise such as Tai Chi. Very few patients can’t do even that kind of exercise. When they start to have confidence and build up their confidence with exercise, then over time they were able to persevere and do it more. And I want to also emphasize there's the positive impact of exercise on mood, and many people with mental health issues, such as depression, actually get positive benefit from exercising regularly.

Dr. Alsuwaidan:

Great practical tips. Other than Tai chi, are there other forms of exercise you recommend to your patients?

Dr. Choy:

Yeah, I think everybody needs to find the form of exercise that suits them. So I've mentioned Tai chi, but there are others. So patients who actually find it helpful to use a game console like Xboxes, to do gentle exercise at home if they don't want to go outside, particularly during unusual period when we have to do self-isolation. Or yoga or Pilates. People who like warm water, you don't need to able to swim. You can just wade through waist-high water as a form of exercise. All forms of exercise are beneficial. Individuals need to find the kind of exercise that suits them, that matches with their lifestyle. And we need to encourage them to persevere and carry on, and not give up easily.

 

 

Narration: Julie is on Dr. Choy’s wavelength, and puts it another way.  

Julie:

It's hard to get moving and move through and to understand that your motion is lotion, and even if it hurts a little bit right now, it's helping in the long term. It's hard to maintain a healthy weight. It's hard to have a sense of identity in a disease that a lot of people don't understand or have incorrect assumptions about. And we can do all of those things. We can overcome all of those things when we become advocates for ourselves, and advocates for our care, and that is a really long journey. I think it mirrors some of those phases of grief and acceptance and finding meaning. And I always like to say, you know, "You don't have to get there immediately."

 

Narration: Rebecca uses a creative slow and steady approach with the people she works with.  

Rebecca:

One of the things that I like to always say with patients too, is "What do you enjoy?" Before walking is a great entry point, so is swimming or walking in a pool, any kind of aquatic exercise is a great entry point for somebody who has not been active. But walking is a simple task. You don't have to spend any money to do it. You don't have to go to a specific place if you don't have a pool, right? You can just do it in your house. You can start doing a lap around your coffee table and just walk and then build up and then you add more steps to your house, and then maybe you're going to the mailbox, and then maybe you're walking up and down your block, and then you just keep building and adding every couple of days as you feel better.

Rebecca:

There's something out there that we could turn into a physical activity to get you moving your body in a joyful way. Dancing. One of Julie's favorite things, and me too, but Julie likes to have daily dance parties and I love dancing too.

 

Narration: Clearly, doing something physical – anything you can manage as well as enjoy – is a great place to start and build from when balancing physical exercise with pain management and emotional wellness.  

 

Part 6: Last words and recommendations

Dr. Alsuwaidan:

What final message do you really want them to take away from our discussion today?

Dr. Ernest Choy:

Well, one of… I think we want to say is that pain is very complicated, especially chronic pain. It always leads to distress and an emotive response. And the management of pain needs to have a very positive mental attitude. We need to get individual to exercise regularly, help them to sleep better, and get them to have a healthier lifestyle.

Dr. Ernest Choy:

And that is really as important as giving them just a painkiller. And explain to them that pain is not just about trying to relieve pain completely. In patients with chronic pain such as osteoarthritis, it is to support the individual to positively manage and cope with the pain. So the goal is not about having no pain at all.

 

Narration: Rebecca and Julie agree that setting expectations and supporting self-management are both key, along with a healthy dose of self-advocacy.  

Rebecca:

It's not just about the medical things, it's about me being able to say, "I've heard about this or I've tried this and this isn't helping. I know you want me to lose weight, but this isn't happening. What are some ideas you have? And I've, I've researched these several ideas, which do you think is best in my situation?" So I think that patient education piece is so important. And once somebody really feels like they can own that and they understand that and they know how to communicate about it, it gives them the ability to really go back to that healthcare provider, and also make the choice of, "You know what? Maybe you're not the right doctor for me and I need another opinion. Maybe I should go see somebody else. Maybe there's a different alternative type of therapy that I can seek out.” But always knowing that I have a voice and I should come to these doctor's appointments with questions and answers. So I think that's patient education goes a long way for people to feel a little bit more empowered.

Dr. Alsuwaidan: Thank you for joining us today.

Julie:

Yeah, thanks for having us.

Rebecca:

No problem, thanks.

Dr. Ernest Choy:

Thank you. Pleasure.

 

Dr. Alsuwaidan:

All right. I recently read an article written by someone living with chronic pain. In it they write, how it would be nice to hear people say, "I hope you're as well as possible". So for all you listeners out there living with chronic pain and depression, that's my wish for you. I hope you, are as well as possible. Also, remember what Rebecca and Julie said, don't suffer in silence. Speak to your doctor and reach out to friends and family for help when you need it. I'm Dr. Mo Alsuwaidan. Thanks for listening.

Brought to you by Viatris, empowering people worldwide to live healthier at every stage of life.

Powered by Viatris