A small trial found that guideline-based workouts at home or the gym lowered pain intensity for some participants, but researchers say larger studies are needed.
For many people living with spinal cord injury or disease (SCI/D), the hardest part isn’t the loss of function. It’s the chronic pain, which some describe as harder to live with than the injury itself. A new study from UBC Okanagan suggests that a structured exercise program, done at home or at a local gym, may help some of them.
Much of this pain is neuropathic, meaning it comes from damage to the nervous system. That makes it hard to manage with common painkillers. Unlike a loss of physical function, which people can adapt to and learn to live with, this pain can flare unpredictably and at varying intensities.
“People with spinal cord injury have told us for years that they use exercise to manage their pain, but we didn’t have strong evidence on how to prescribe it,” the study’s lead author, Dr. Kathleen Martin Ginis, a professor in UBC Okanagan’s School of Health and Exercise Sciences, said in a news release.
The study, published in Archives of Physical Medicine and Rehabilitation, tested whether prescribed exercise done in everyday settings could reduce that pain. More than 150 people with SCI/D and 50 clinicians helped shape the study.
The researchers enrolled 46 adults. Some had neuropathic pain; others had musculoskeletal pain, such as the shoulder strain that builds from years of pushing a wheelchair and making transfers. Participants were randomly assigned to one of two groups.
Half received a personalized program based on international SCI exercise guidelines: at least 20 minutes of moderate-to-vigorous aerobic exercise twice a week, plus three sets of strength exercises for each major functioning muscle group twice a week. They also received support from a certified fitness trainer, one 5-15 minute weekly counseling session, and could exercise wherever suited them, at home, a local gym, or a community center. The other half continued their usual activities.
Pandemic restrictions, wildfire evacuations and university policy changes repeatedly suspended the trial, and the researchers were unable to recruit as many participants as planned. Of the 46 people enrolled, 39 completed the six-month follow-up.
On the study’s main pain measure, which combined pain severity and how much pain interfered with daily life, the exercise program didn’t make a clear difference. However, on a pain-intensity measure designed specifically for spinal cord injury, the exercise group reported statistically significant decreases at three and six months compared with the control group.
At three months, the exercise group also reported less pain interference in daily life and more energy and vitality. At six months, eight of 18 people in the exercise group (44%) reported a pain reduction of 30% or more, compared with two of 16 (13%) in the control group. Responses varied widely, though. Some participants reported little or no change, and a few reported more pain.
Participants stuck with the aerobic workouts more consistently than the strength training, which the researchers say suggests that aerobic exercise may be especially important. .
The trial was conducted at UBC’s Kelowna and Vancouver campuses. As with any new exercise program, check with your doctor before starting.
“This isn’t a cure-all, and we need larger trials to confirm these findings,” Martin Ginis said.
