Analgesics - A discussion for use with home exercise planning

25th March 2015

In recent years the question of whether to use or not use pain killers seems to be getting more common. The over use of pain killers in past times, and the concern over how damaging they may be to the detoxification systems of the body, has led many people into believing that over-the-counter pain killers and anti-inflammatories should be avoided at all costs.  

But should they? Do they have a place in the rehab process?

Studies have shown that worsening pain during exercise programmes was a barrier to adherence (Minor and Brown, 1993; Dobkin et al, 2006). This indicates that strategies to minimise pain are important in keeping a client compliant with the progression of their home exercise plan. 

So why do would a perceived increase in pain during the rehab process cause clients to become non-compliant? It seems due to the pain cycle within the brain. This happens because the body perceives pain as a stress, and stress is perceived as a danger by the body. By the time a person comes to seek out the help of a therapist they have decided this pain is not going away on its own, and therefore are likely to have become concerned. What the therapist does next is subconsciously going to confirm or deny those concerns. 

A perceived persistence to the pain will increase stress and firmly lock their brain into associating that injury area with pain. A perceived reduction in pain should alleviate stress and concern, and allow their brain to disassociate pain with the injury site. In simple terms it should look like this:

What to use.

For me the best analgesic is cold. Depending on the tissue depth this could be ice or simply a cold flannel placed on the area regularly. Physicool is another great product where a bandage is soaked in alcohol to use evaporation as a means to cool the tissues. This enables people to remain mobile (especially during working hours).

NSAIDs and pain killers are also useful in the short term. Many people refuse them but I like to think of them as a way to quickly achieve my pain reduction goals, and short term use will have little, if not zero, detrimental affect on the detoxification systems of the body. Our thinking being that to block the brain’s pain associations early on will remove this as a limiting factor as they progress. Always have the patient seek advice from their GP incase patients have allergies to these drugs.

All-in-all the aim is to keep your client motivated on their home exercise plan. If pain is an inhibiting factor they are more likely to stop their exercises due to a perceived lack of progress. The use of analgesics, be they cold compress or drugs, helps to reduce the stress associated with pain. The stress and worry of unresolved pains can intensify symptoms, even when tissue damage is not present, so stress management is an important consideration from the outset. 

ExerciseLab’s video library helps you keep your clients on track and progressing through the stages of recovery. By allowing your clients to find success in each exercise, and by reducing pain as quickly as possible, you’ll find clients have greater participation to home exercise.