PhysioUpdate 7th February 2023

All medicines carry an inherent risk and other options are more likely to help people ‘live well with pain’, according to two UK-based experts on the topic.

In an editorial appearing in the latest issue of The BMJ, Cathy Stannard and Colin Wilkinson say there is ‘good evidence’ for the benefits of group exercise, delivered by appropriately skilled instructors.

‘Exercise and physical activity have many other health and wellbeing advantages in addition to useful improvements in symptoms for people with pain,’ they suggest.

Dr Stannard, a former consultant in pain medicine, is based at NHS Gloucestershire Integrated Care Board, while her co-author, who ‘lives with pain’, is based at the University of Bath’s Centre for Pain Research. Both have helped to produce guidelines on pain published by the National Institute for Health and Care Excellence in recent years.

The pair comment on a research paper appearing in the same edition of The BMJ, which presents an overview of the effectiveness, safety, and tolerability of antidepressants for pain according to condition. The authors of the research paper acknowledge that while some antidepressant drugs can be effective in some pain conditions, most are either ineffective or lack conclusive evidence for their efficacy.

Middle aged people should look out for tell signs of being overweight – such as a midriff bulge – as they face a heightened risk of physical frailty in older age, according to a research paper appearing in BMJ Open yesterday (24 January).

Frailty is often wrongly perceived as a purely wasting disorder, say the researchers, who emphasise the importance of keeping trim throughout adulthood to help minimise the risk.

Frailty is characterised by at least three and pre-frailty by from one to two of the following five criteria: unintentional weight loss; exhaustion; weak grip strength; slow walking speed; and low physical activity levels. It’s associated with vulnerability to falls, disability, hospital admission, and a reduced quality of life and death. 

Mounting evidence suggests that obese older adults may be at increased risk because obesity aggravates the age-related decline in muscle strength, aerobic capacity, and physical function. But few studies have tracked weight changes and frailty risk over the long term.