Background & Aims
Chronic pain continues to be difficult to cure, creating a pressing need for new management strategies [1]. Recent studies have identified the immersive environment of ocean surfing as a method to give respite to symptoms of disorders related to neural function [2]. Previous work from our lab has characterized neural dysfunction patterns in patients with multiple Chronic Overlapping Pain Conditions (COPCs) [3]. However, the benefits of surf therapy have yet to be validated in the chronic pain population. The current aim of this study is to explore the benefits ocean surfing has on patients suffering from multiple COPCs, specifically with chronic pelvic pain, through qualitative pain score assessments along with identifying any potential neural markers associated with pain changes via electroencephalography (EEG).
Methods
Data was collected in Southern California from nine patients suffering from chronic pelvic pain with at least one other overlapping chronic pain condition (3 M, 6 F, 30-62 years old). We collected resting-state EEG as well as clinical questionnaire and self-reported pain data. EEG data was collected using a 4-channel MUSE device collecting at 256 Hz. Study design included four beach session visits in which EEG collection and pain score questionnaires were completed before entering and after exiting the water during each surf session with experienced surf therapists. To help identify potential mechanisms of this therapy, one group (4 patients) was given an additional pain score questionnaire at their arrival to the beach to control for general exposure to the natural environment, and a second group (5 patients) was given a retrospective questionnaire after each surf session in which they identified when they believed they started to feel a reduction in pain.
Results
We observed a significant reduction in pain scores from participants following surf therapy sessions with an estimated average pain decrease of 50%. Additionally, pain scores at arrival to the beach and right before entering the water did not significantly differ, and most responses to the retrospective questionnaires pointed to pain reductions occurring when participants were in the water. Aggregate spectra from the four EEG channels revealed the largest surfing-related change associated with pain relief was spectral power in the delta band (2-4 Hz); specifically, larger surfing-related increases in delta band power were associated with greater reductions in pain.
Conclusions
These findings provide proof-of-principle evidence that the activity of surfing may be a means to alleviate pain even in patients with multiple chronic overlapping pain conditions, specifically those with chronic pelvic pain. These pain results are further supported by preliminary findings on the objective changes in brain activity that are correlated with the subjective pain reports. This study provides critical groundwork for future research on how immersive activity can play a role in the management of complex chronic pain.
References
1. Simon LS, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Press 2011.
2. Walter KH, Otis NP, Ray TN, Glassman LH, Beltran JL, Kobayashi Elliot KT, Michalewicz-Kragh B, A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder. BMC Psychiatry 2023; 23:109.
3. Kutch JJ, Ichesco E, Hampson JP, Labus JS, Farmer MA, Martucci KT, Ness TJ, Deutsch G, Apkarian AV, Mackey SC, Klumpp DJ, Schaeffer AJ, Rodriguez LV, Kreder KJ, Buchwald D, Andriole GL, Lai HH, Mullins C, Kusek JW, Landis JR, Mayer EA, Clemens JQ, Clauw DJ, Harris RE, Brain signature and functional impact of centralized pain: a multidisciplinary approach to the study of chronic pelvic pain (MAPP) network study. Pain 2017;158:1979-1991.