Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

The Walking Sad

When it hurts, a positive attitude and a pair of Vans can help.

We are all guilty of it: walking sad.

You walk to the market, head down, thinking of the clumsy words spoken on that first—and ultimately last—date with that pretty young woman the software declared was such a perfect match.

You take the longer route to deposit something at the bank, high heels keeping rhythm to the thoughts of that ex-boyfriend with whom you expected to window shop during the holidays, each of you imagining—if not sensing—caresses through knit sweaters and Gore-tex gloves.

When the day is particularly frigid and dark, then come the images of Ratso Rizzo, and that harmonica of Toots Thielemans, and you are exercising in some grotesquely beautiful prison yard, housed between walls of weeping and wailing.

And those words of Hopkins, about some grove unleaving, as you walk by the stern signs warning of the imminent arrival of the last neighborhood leaf pick-up of the season.

We walk sad. But is it good for us?

Walking is the last bastion of at least a semblance of keeping physically fit for many adults. It is one way to reduce the risk of cardiovascular disease, cancer, and diabetes. Unfortunately, for many, chronic pain is the limiting factor in engaging in a regular walking program. For many, the pain is often due to severe knee pain.

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However, psychological pain—mostly in the form of depression—is also strongly associated with decreased physical activity. Interestingly, the absence of depressive symptoms appears to not be sufficient to promote daily walking: A high positive affect (the absence of depression coupled with a positive attitude) appears to be the driving factor here.

We are talking Happy.

This is important; because individuals with, say, degenerative joint disease of the knee generally do not engage in sufficient physical activity. It is important to identify psychological factors that encourage activities such as walking. Persons with knee pain may need to draw on psychological resources such as a high affect in order to continue their walking habits.

The results of a study published a couple of months ago in “Arthritis Care and Research” found that positive affect was not associated with more daily walking among adults with simply a diagnosis of knee arthritis. However, among subjects with knee pain, those with high positive affect walked more compared with those subjects with a low positive affect. In contrast, those without knee pain walked a similar amount per day, regardless of the presence or absence of positive affect; but the presence of negative and depressive symptoms was associated with less daily walking among subjects without knee pain.

High positive affect is an important psychological feature associated with daily walking in pain sufferers.

Positive psychological factors appear to have a great importance when one’s health is at risk. The clinical implications are vast: It appears that a positive affect is not just a trait, as other studies have successfully used interventions to increase positive affect in persons with cardiopulmonary disease, and with newly diagnosed HIV. In fact, the cultivating of a positive affect has resulted in increased physical activity in subjects with asthma and hypertension.

As physical activity is recommended to reduce the risk of poor health, it is important to identify factors, such as a positive affect, that will hopefully drive an active lifestyle. The physical depends on the psychological. But what else, really, is new?

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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