Here is an excellent article by fellow chronic pain blogger at The Princess in the Tower. It is such an important topic and gave me new ways to think about pacing. Please continue reading the even more important second part on her website, and check out her Facebook page. She offers information about chronic pain and in particular RSD/CRPS and Fibromyalgia from a personal perspective. Enjoy.
Pacing to Manage Your Pain
The first rule of chronic pain management is pacing. Finding the exact amount of activity you can do without causing a flare-up of symptoms is almost an art form. The trick is to work out your time limits on activities such as sitting, standing, walking etc., and how long you can do each activity on a good day and how long you can do them on a bad day.
By limiting yourself to always stopping after the length of time you could do the activity on a bad day, you won’t push yourself to do more on a good day and consequently suffering for it the following day.
Pacing is a concept that pain specialists and pain psychologists instruct every client who is suffering from chronic pain. Many chronic pain sufferers are naturally far less active than they used to be and as a result, you may have
noticed yourself trapped in a cycle of ‘boom and bust’ with activity and exercise (more details below).
An example of this is someone who wakes up one day and feel they are having a ‘good day’ and so decide to catch up on things while pain levels are manageable. Later that evening the symptoms are flared-up again, resulting in extended rest and ‘bad days’. Eventually it settles and the pattern is repeated again when they feel a bit better.
Another pacing problem is around those day to day chores that need to be done. These are the normal Jobs at work and home that build up around us. If there is a day when you feel better the the temptation is to try and do everything all at once because you don’t know when the next opportunity will be.
A third approach is the ‘never give in’ attitude. Refusing to let the pain beat you and stop you from doing what you want and need to do. This is when it feels you are at war with your pain and you are not going to let it win; the result is harmful on both a short and long-term basis.
With all these ways of approaching activity, it is followed by more pain and for some more inactivity follows as you try and settle it down – the ‘boom and bust’ cycle (see below). Your baseline level of fitness never really improves
– if anything it gets worse.
Repeated flare ups of pain lead to more feelings of loss of control, anxiety and isolation as the cycle of chronic pain continues and even worsens. A pacing problem is basing your activity level on how you feel (doing more when you feel good and less when you feel bad).
Good pacing involves basing your activity level on pre-set, reasonable goals – not on your level of pain. To remedy a pacing problem, you will need a Pacing Plan that will help you to gradually increase how much you do of an activity, slowly and safely.
Avoiding Activity
It’s natural to avoid an activity, especially when you know it will make your pain worse. Forcing ourselves through the pain and trying to keep going for as long as we physically can is also a recipe for disaster. An example is when a pain patient is at home and finds it painful to sit up but then tries to do so on a rare meeting with friends only to pay severely for that later.
This may also mean that they are naturally very reluctant to try it again. They don’t want to spend their lives in bed, living with pain is bad enough without additional flares. Yet there is hope. Even extremely deconditioned bodies can be strengthened and your limits increased. Those who have lived with pain for many years can have an increasingly low activity threshold but do not despair, it can be increased but doing so slowly and using pacing is vital.
Baselines and Thresholds
Baselines and thresholds are judged by the length of time you can do an activity before your pain increases dramatically and cripples you. To begin, it may be as little as 30 seconds and then gently increased in micro amounts every week, never increasing by more than 30 seconds in a week. It can take a loooong time but I guarantee it is worth it.
It is vital to stop before the pain increases too much and becomes unmanageable and flares-up. This enables you to do more things and have a regular amount of activity each day instead of doing one or two things, being in too much pain to do anything more and being disappointed and in more pain, unable to do anything, possibly for the entire next day. Look at the example below: CONTINUE TO READ
Image excerpted from The Princess in the Tower Pacing blog