Education and Exercise Program for Chronic Pain Patients
The incidence of chronic non-cancer pain (CNCP) ranged from 16-36% in a Canadian 2004 survey; 88% of which reported moderate to severe pain.1 CNCP is the most common reason for physician visits in Canada, most often arising from back, neck, and joint pain.2 Usually, chronic pain patients require more time per physician visit, suffer more feelings of distress and more disruption in functioning and use more hospital and other health services.3,4,5 Further, daily occupations of individuals living with chronic pain become restricted due to energy, frequently occurring co-morbidities such as depression, and social repercussions of their illness.6
A vicious positive feedback cycle can develop in chronic pain such that physical changes including decreased activity result from altered pain levels, which in turn cause stress, tension, emotional dysfunction, leading to further pain which then leads to greater physical changes, etc.7 Physical exercise and/or self-management techniques are interventions which have often been used to decrease pain and increase activity level for individuals with CNCP.8 Self-management (behavioural therapy) programs have resulted in improved function,8,9 decreased pain,9,10 enhanced self-efficacy,9,11 improved health behaviours,11 and increased life satisfaction10 in a variety of conditions resulting in chronic pain. Exercise programs have more specifically resulted in improvements in physical function and reductions in pain in a variety of populations with chronic pain12-16 and, in some instances, improved one’s sense of well-being.12
Access to chronic pain specialists is limited Canada-wide.17 Community-based programs to assist individuals in coping with their chronic illnesses have been developed for many conditions (i.e. diabetes, asthma, psychiatric diseases, arthritis, heart disease). However, to our knowledge this is not the case with CNCP. A group of interested health care professionals and the local Kingston Family YMCA partnered to develop a 12-week education and exercise program (Y-PEP) for individuals with CNCP. The purpose of this study was to determine if this program enhanced physical function, psychosocial well-being, and perceived quality of life in individuals with chronic pain. It was hypothesized that following completion of the Y-PEP, individuals with chronic pain would have an improved level of physical function for participation in activities of daily living and an improved quality of life as indicated by lower indices of depression, perceived pain and pain catastrophizing, and enhanced coping ability.
Twenty-five subjects were recruited from the practices of the YPEP Advisory Group physicians and their colleagues. In order to participate individuals had to:
- be 18 years of age or older,
- have had chronic pain for greater than 6 months,
- be under physician management of pain,
- have medical clearance to participate,
- be able to ambulate,
- have the capacity to tolerate sitting for >10 min,
- be capable of providing informed consent (fluent in English, lack severe cognitive impairment).
To ensure participant safety and appropriateness for entry into the Y-PEP, each individual was required to submit a completed PARMED-X form (© Canadian Society for Exercise Physiology) which was completed by their physician.
|Variable||All Particpants (n=10)|
|Age (years)||45.6 ± 9.9|
|(average # per participant)|
|Frequency of Medications
(narcotic & non-narcotic)
|Not every day||1|
|1-2 times per day||2|
|3-4 times per day||5|
|>6 times per day||1|
|Age and medications are reported as mean ± SD. All other values represent the number of participants in each category|
Participant Demographics. Demographic information was obtained using a questionnaire to record participant age, height, weight, level of education, marital status, employment status, primary diagnosis, other existing medical conditions, other treatments attempted, medications, and any related side effects of these medications.