The paradox of physical activity and pain for children with juvenile idiopathic arthritis

For children with juvenile idiopathic arthritis (JIA), physical activity occupies a paradoxical relationship with pain. Participating in physical activity can make pain worse and pain is often cited as a barrier to activity participation. However, regular physical activity over the longer term has been shown to help reduce pain, fatigue and disability and to improve quality of life. Patients beginning an exercise program struggle with this apparent contradiction especially during the first several weeks until functional improvements are observed. It is the role of clinicians to support patients to remain active and explain the possible harms and benefits of physical activity. Patients must continually strive for a level of exercise that stresses their systems sufficiently to improve function yet avoid a level that causes an excessive symptom reaction, signalling that the patient has exceeded a safe limit. It is important to understand the relationship between physical activity and pain in order to support children in pursuing increased activity levels, both as a pain management method and for their general health. This commentary will explore the relationship between physical activity and pain: (a) by summarizing the evolutionary, physiological and psychological processes that contribute to avoidance of physical activity when in pain, and (b) by reviewing the current literature on the benefits of physical activity for children with JIA. Juvenile Idiopathic Arthritis