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Without getting too theoretical, here is just a glimpse into what recent research shows:

  • Exercise can do everything from treat depression to improve memory, with the power to cure a host of problems while preventing even more.

  • Exercise leads to the release of certain neurotransmitters in the brain that relieve pain, both physical and mental.

  • Exercise generates new neurons in the brain.

  • Exercise improves your mood as well as your capacity to think, concentrate and learn.

  • Active mice regenerated more of the sciatic nerve fibers  after an injury than lazy mice.

  • The brain starts to lose nerve tissue beginning at age 30. Regular aerobic exercise reinforces neural connections and then the brain is better able to process and store information. This suggests possible preventive and therapeutic effects for diseases such as Alzheimer's.

  • It is possible to exercise to happiness. It has been shown that physically active people recover from mild depression more quickly, and physical activity is strongly correlated with good mental health as people age.

  • Depression is related to low levels of certain neurotransmitters like serotonin and norepinephrine. Exercise increases concentrations of these neurotransmitters.

  • The most essential neurochemical for managing chronic pain is endorphins. They make you “feel good.” Endorphins are released in response to exercise. Their function is similar to opioids taken by mouth, i.e. they relieve pain.

  • Exercise stimulates the release of endorphins within approximately 30 minutes from the start of activity. These endorphins tend to minimize the discomfort of exercise and are even associated with a feeling of euphoria.

  • It improves strength, flexibility and endurance. It gives you better posture.

  • Regular aerobic exercise improves creativity and gives birth to new ideas.




WALKING IS THE BEST EXERCISE AT ANY AGE, FOR ANY INJURY! (But please do check in with your physician before you begin.)


Walking is a low-impact, accessible, aerobic form of movement that can benefit almost everyone, especially those with chronic pain. It can be done anywhere, anytime !


It allows you then to gradually wean off from depending on drugs and learn to depend on your own body’s endorphins for pain management and happiness. In fact, as noted above, these same chemicals also help with mental clarity and creativity, allowing you to be more productive at home and at work.


What not to do: Most obvious mistake many patients make is that after having been sedentary for weeks or months, they will just go all out and walk for 2 hours. Of course, then they are going to make all their symptoms worse and will want to stay in bed for 2 weeks to get over the pain. It might be another 2 months before they are motivated to exercise again. This yo-yo kind of activity is harmful in the long run. In addition to deconditioning, the patients start to believe that exercise is bad for them.



Pacing is the key. Gradually increase your walking tolerance, starting with exactly where you are. Don’t be in a hurry to do too much.


If you can currently walk only 5 minutes at a time, then begin there, and add 1 minute each day till you get up to 30 minutes a day.


Stick to this gradual increase plan, even if you feel a little sore for a few days.


Ultimate goal could be to walk at a brisk pace 30 minutes a day, 4 times a week. But if your condition allows you to walk only 10 minutes at a time, then do so 2-3 times a day. 


Set aside time for exercise, when you are walking just for exercise. It is good to get other opportunities to be active too such as grocery shopping or watering the garden, but please do not think of grocery shopping or watering the garden as your exercise for the day.


Gradually also add stretching and strengthening exercises to your routine, for about 15 minutes a day. 


Other beneficial styles of exercise:

  1. Yoga or Qi Gong: These exercises that involve slow, purposeful movements that can often be adapted to your limitations. These practices are done mindfully, paying attention to breathing and sensations in the body and that allows the blood flow and oxygen to circulate in tight areas allowing them to relax and heal. It is best not to do these exercises while watching TV.

    There is early research supporting the use of qigong for pain management and reduction of anxiety associated with pain. Using Qi Gong techniques, even simple minimal stretches can be deeply helpful. There is considerable evidence of efficacy for mind-body therapies such as yoga in the treatment of chronic pain.

  2. Aquatic therapy: A favorite choice especially for older individuals as buoyancy of water decreases stress on joints and muscles. Water resistance prevents sudden movements that could cause re-injury while maximizing muscle strengthening.

  3. Riding a stationary or recumbent bicycle: No force on joints and spine makes riding a bike both indoors and outdoors more suitable option for many.

In this section:
Sleep Management


Active participation

Research has shown us that when the patient and the physician share the responsibility of recovery and together figure out how to best manage the pain, the outcomes improve significantly, as compared to when the patient is just a passive recipient of treatment. 



Understandably, patients want their chronic pain “cured” or eliminated. Unfortunately, no definitive cures currently exist for the majority of persistent pain problems. When it cannot be cured, chronic pain must be managed. Acceptance of this fact is the first step to managing your chronic pain.


In the self management model, the emphasis is placed on encouraging patients to accept some pain and to make an effort to improve function and quality of life. This bio-psycho-social approach emphasizes participation in daily activities despite pain. However, instead of just telling the patient to “move on with your life”, specific guidelines are provided to help you manage your pain and improve your functional capacities.



Self-efficacy is about having control over your pain. Believing that you can perform a task or respond effectively to a situation can actually improve your ability to tolerate pain and improve your capacities. This leads to improved sense of well being.


Change negative thought patterns

Catastrophic beliefs” about the pain: Imagining or believing the worst outcome can actually have a debilitating effect on the psyche and immune system. This can perpetuate chronic pain, and lead to further depression and inactivity. Changing catastrophic thinking can improve pain, functional capacities, and mood. This has been proven to be the most important factor in managing chronic pain.


Victimization is a feeling that you are in this "horrible situation" and the fault lies with some one else, whether its the insurance company not paying for treatment, or the employer not taking care of paperwork or the physician not treating it right. But this feeling is actually shown to be associated with poor outcome of treatment. Thus, you may be setting yourself up for chronic pain!


Fear of re-injury is a barrier to healing and perpetuates the pain because it engenders inactivity. Patients with chronic pain may believe that activity will lead to increased pain and cause physical damage. This belief, while typically true in acute pain, is often inaccurate in chronic pain. Being objective about the possibility of re-injury helps deal with this fear while being active. Negative thoughts will have a detrimental effect on pain. Often times, one of the greatest challenges for those with chronic pain is the belief that they can no longer engage in life fully or do the things that they want to. Continuing to engage in daily life is essential.


Inactivity leads to decreased flexibility and stamina, increased weakness and fatigue. This leads to deconditioning which actually leads to increased risk of re-injury and weight gain, as well as feelings of sadness, frustration, or boredom, which only encourage more general withdrawal from people and places. Thus, regular exercise and active life style need to be integrated into daily life once again.


Multi-modality approach to self management of chronic pain:

  • Healthy nutrition

  • Regular exercise

  • Sleep management

  • Stress management

  • Management of anxiety and depression

  • Medication optimization

  • Coping skill


This approach may not cure your pain, but it will:

  • Reduce pain intensity

  • Reduce the negative impact of pain on your life

  • Improve your skills to cope with and manage pain

  • Improve your physical and emotional functioning

  • Help you get back to work and reduce financial stress

  • Help your family relationships

  • Give you a sense of control and optimism

  • Improve your overall quality of life


This is not a quick fix. We are trying to make life style modifications that will not only help your pain, but your state of health and well being for the long haul. So, please allow 6-8 weeks and then you will see a dramatic change both in your pain and in your life. 


Let's begin . . .



Going into the details of dietary guidelines is beyond the scope of this website, but I will offer few general guidelines.


  • Avoid too much snacking and junk food.

  • Eat three meals a day with plenty of fresh green vegetables at each meal.

  • Eat balanced diet with some protein at each meal (eggs, chicken or beef) but avoid processed food with additives and preservatives in it.

  • Replace white with brown, e.g. brown sugar, whole wheat flour and brown rice are better for you than white refined products.

  • Eat when hungry and not in response to emotional distress. Do not use food to soothe yourself.

  • Eat slowly and chew each bite fully; you start to feel full in 20 minutes no matter what speed you eat at.

  • Limit sugar intake. It may make you feel good for a short while, but then there is a crash of energy. Replace sugar in your diet with complex carbohydrates such as vegetables and whole wheat flour. This will give you balanced energy through out the day.

  • Minimize alcohol use.



Insomnia is not a disease, but a symptom of a problem. Sleep difficulties can be related to pain, a chemical imbalance, a hormone imbalance, infections, allergies, arthritis, or headaches. Coughing can cause you to sleep poorly. Insomnia can be a side effect of many medications. Alcohol can also interfere with sleep. In majority of cases sleep difficulties are related to psychological difficulties. Waking up too early is common for people who are depressed and difficulty falling asleep is often caused by anxiety.


When you are sleep deprived, you become less alert and attentive, more inclined to irritability and other mood problems that can make relationships with family, friends and co-workers difficult, and your concentration and judgment suffer. Your ability to perform even simple tasks declines and your productivity is reduced.


Scientific studies have confirmed that practicing good sleep hygiene is as or more effective than medication treatment in improving the quality and quantity of sleep.


How much sleep each person needs is variable, some feel rested after 5 hours of sleep while others need 8 hours of sleep to really feel rested.


Poor sleep can lead to fatigue, muscle tenderness, irritability, decreased daytime activity and difficulty with concentration. This can start a downward spiral of poor sleep leading to increased pain which in turn can lead to more sleep difficulties.


Please talk to your physician to determine if sleep difficulties could be related to medications or other medical problems.


Sleep hygiene is what you can do to improve your sleep.


Factors contributing to sleep difficulties:

  • Resting in bed during the day: This is common for patients with chronic pain but can have a negative impact on sleep. Using the bed to rest when experiencing a pain can create an association between the bed and suffering. Spending time resting in bed during the day increases the chances of falling asleep during the day. Napping during the day makes it difficult to sleep well at night.


  • Inactive life style: Too much rest during the day impairs sleep. Increasing activity during the day can help sleep by increasing nighttime tiredness. But please do not do intense exercise within four hours of bedtime. Using relaxation techniques at bedtime will not only help sleep, but avoid flare ups as well.


  • Opioids: Opioids can cause drowsiness making falling asleep easier but they may also exert a negative impact on sleep cycles making it difficult to achieve deep, restorative sleep.


  • Alcohol: Alcohol at bedtime may make you feel sleepy and relaxed but later in the night, it will lead to restlessness and disturbed sleep.


  • Caffeine: Caffeine can remains in the body for up to 10 hours after ingestion making it difficult to sleep soundly and deeply.


  • Smoking: Nicotine remains in the body for about 2 hours and then causes withdrawal and potential agitation. While smoking may feel relaxing, nicotine only relieves symptoms of withdrawal. It is best not to smoke for 2 hours before bed time.


  • Heavy meals: Heavy meals at dinner can induce indigestion or acid reflux, which will disturb sleep. Light snack is best in the hours just before bedtime. If you need to get up at night to urinate frequently, you should also limit your fluid intake in the evenings.


  • Schedule: Erratic schedule can be disruptive. Establishing a good routine helps.


  • Bedroom: Environmental factors, such as room temperature, noise, light, and smells, can impact an individual’s ability to fall or stay asleep. Bedroom needs to be a cool, dark, quiet place free from sensory distractions, such as blinking lights from computers and ticking clocks. You may want to use a fan for ambient noise and to circulate air.


  • Emotional Issues: You may believe that sleep will not improve unless pain improves first, leading to resignation and hopelessness. Or you may feel that you first need to resolve your anxieties before you can sleep. You do need to address these issues, but you just need to address them the next day during the day time when you are well rested instead of letting them percolate in your mind and keep you up all night.


Sleep Hygiene:

  • Only go to bed when sleepy.

  • Use bed only for sleep and sex.

  • If unable to sleep within 20 minutes, get out of bed and return only when sleepy.

  • Go to bed and wake at the same time every day.

  • Do not nap.

  • Environment: manage noise, temperature and light in the room.

  • Avoid watching the clock or counting down time.

  • Worries may surface once the house is quiet and dark but this is not a good time to problem-solve. Practice relaxation techniques instead.

  • Set aside time earlier in the day to focus on troubleshooting issues.


Multi-modality approach continues on next page

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