A gradual exposure process can be used to acclimatize patients to physical activity, so they learn how to move in a safe way under the proper guidance.
The Power of Words, Perception
“One thing that can affect pain catastrophizing is threatening or frightening illness information,” states Dr. Opava. “While some health professionals do advise patients in pain to avoid physical activity, it is not likely that they would admit this. Frankly, it seems that many healthcare providers are not saying ‘avoid activity’ outright. … It’s just that they are unconsciously sending signals to take it easy and rest a lot when in pain.
“And if healthcare providers are telling patients that physical activity doesn’t harm their joints or increase pain—and if they are not accustomed to exercising—then they are probably not going to start.”
Dr. Opava offers the following advice:
- The message to move should initially come from the physician or nurse, but if further counseling is necessary then a physical therapist can be brought in to more fully explain things; and
- A gradual exposure process can be used to acclimatize patients to physical activity, so they learn how to move in a safe way under the proper guidance.
She says, “This process is frequently used with patients experiencing low back pain. In patients with RA, however, it is not used systematically because it has long been considered that pain is strongly related to inflammation, and thus, if you exercise, you increase the inflammation activity—but that is not the case in the majority of patients. We actually have data suggesting that exercise reduces pain and inflammation.”
Counseling Patients
It can be challenging to act as part physician, part psychologist, but given the results of this study, it might be a bit easier. Regarding how to counsel patients, Dr. Opava says, “Ask, for example, ‘Are you afraid of moving because you are concerned that your knee or arthritis will worsen?’ If the answer is ‘yes,’ then try to convey that the information you are giving them is evidence based. And if the next time you see the patient, she or he is not active, then have them meet with a physical therapist. In addition, we have found that it helps if a health professional works with the patient to set SMART [specific, measurable, attainable, relevant, and timely] goals. You can, for example, have them agree to take a walk around the block and then, when that goal is reached, set a new higher goal.
“Given our findings, we now have a better idea of how to target our resources. Patients need information that can help calm them down, help them understand the signals that their bodies are giving off, arrest the catastrophic thinking and get them moving.”
