Applying Kinesiology as a Multi-Prong Approach to Pain Management
Pain clinicians can apply the principles of kinesiology to enhance a patient’s quality of life. In academia, kinesiology refers to the melding of various aspects of care that “focuses on movement and physical activity” to enhance quality of life.1 In the realm of pain management, this means:
- Exercising for enhancement of health and fitness level
- Learning movement skills
- Engaging in activities of daily living, such as doing chores, working, or playing sports.
The advantages of this approach include reduced use of medications and the psychological benefits of remaining active and engaged in life. This article reviews the benefits of kinesiology to enhance the effectiveness of multidisciplinary pain management, with a special focus on elderly patients.
What Is Kinesiology?
Kinesiology comprises many specialized areas of study and professions that examine and assess causes, processes, consequences, and contexts of physical activity from diverse perspectives.1 Areas of kinesiology include (but are not restricted to) exercise physiology, motor development, motor learning and control, biomechanics, sports management, athletic training and sports medicine, physiotherapy, rehabilitation therapy, measurement and evaluation of physical activity, history of physical activity, psychology of physical activity, philosophy of physical activity, physical education pedagogy, physical activity and public health, and the sociology of physical activity. An interdisciplinary approach involving several of these diverse areas can be implemented in treating and preventing many medical issues, including chronic pain.1
The Problem of Pain
Pain is a widespread health issue that affects approximately 100 million Americans.2 According to an Institute of Medicine (IOM) report, the frequency of pain is highest among elderly Americans,2 who are an increasing proportion of the population (Figure 1).3,4
According to the IOM report, roughly 30% of older Americans suffer from chronic pain, and 50% of community-dwelling older adults suffer from chronic pain.2 Mailis-Gagnon et al found that about 40% of chronic pain cases in the elderly are general musculoskeletal pain, and 35% are peripheral neuropathy.5
The most common causes of chronic pain in older adults include arthritis, cancer, diabetes, cardiovascular disorders, and neurologic diseases.6 Thus, there is a great need for effective chronic pain management interventions for all segments of the population, especially the elderly.
Older adults with chronic pain face multiple barriers, including transportation difficulties, fear of pain or injury, and lack of motivation.7 Because chronic pain is so prominent in this population, it is important to remember the relationship that exists between psychosocial constructs, such as depression, anxiety, fatigue, sleep deprivation, and chronic pain. It is a problem that affects all areas of life, resulting in a decrease in movement, socialization, and sleep.8
Because of their focus on a multi-prong approach to care, kinesiologists are at the forefront of treating chronic pain in the geriatric population as well as the general population.
Exercise, Pain, and Psychosocial Functioning
In 1973, three independent research groups, led by Dr. Solmon Snyder at Johns Hopkins University, Dr. Eric Simon at New York University, and Dr. Lars Terenius at Uppsala University, in Sweden, detected that brain membranes have receptors to which opiates bind.9 Two years later, the neuropharmacologist Hans W. Kosterlitz discovered an endogenous substance with biochemical properties similar to those of opioids, which he called enkephalin.10-12
Intense exercise has been shown to act as a stimulus that promotes hypoalgesia and mood elevation through endorphin release.13 Although researchers have investigated the influence of endorphins, especially ß-endorphins, on the psychosocial concomitants of pain, there has been little investigation of how endorphins influence the physiologic aspect of pain or the aspects of pain processing within the cortex involving interactions among neurons, neurotransmitters, neuromodulators, neuroreceptors, etc (see Neuroscience of Pain).
In 2008, research using positron emission tomography (PET) measured exercise-induced opioid release and its relation to mood.14 The researchers were the first to evaluate the influence of exercise on the endorphinergic system in the central nervous system.14 This study revealed that vigorous exercise resulted in changes in the central opioid receptor-binding that affect mood. Bender et al demonstrated that dynamic and anaerobic exercises increased ß-endorphins.15 In contrast, resistance and aerobic exercises show small effects on ß-endorphins.16
Studies also have found that opioids are released predominantly in the prefrontal cortex and limbic/paralimbic regions, specifically the prefrontal/orbitofrontal cortices, the anterior cingulate cortex, bilateral insula, parainsular cortex, and temporoparietal regions, which are essential in emotional processing.14
Endorphins possess an affinity for µ, ∂, and k opioid receptors. ß-endorphins have both µ and ∂ receptor recognition. However, there is evidence that points to the importance of the link between ß-endorphins and µ-receptors. These receptors are coded by the µ-opioid receptor gene (OPRM1) gene A118G, and are found predominantly in the thalamus, limbic system, and basal ganglia.17 More specifically, these receptors are highly concentrated in the amygdala, nucleus accumbens, and anterior cingulate cortex (ACC).