For people with chronic pain and chronic fatigue, activity can help with pain management, but it can also make things worse.
Does this sound familiar? “Whenever I do anything, I have more pain, so I do as little as possible and end up spending most of the day in bed.” The problem with this is that it leads to boredom and depression, which make pain worse. Being less active leads to weaker muscles. Weaker muscles are painful muscles, which makes pain worse, and increases the chance of further injury when you do get out of bed.
Or maybe you are this person: “I just push through the pain, even though I know I’m going to pay for it. I’m not going to let the pain win.” Unfortunately, the harder you push through pain, the harder the pain pushes back. You can pay the price for hours or days after over-exertion.
Or how about this person: “When I have a good day, I try to get everything done and I go non-stop from morning to night. Good days are usually followed by a stretch of bad days, so I have to take advantage of them.” Another variation of this is “I usually feel better in the morning, so I get everything done in the morning, then I can’t do anything else all day.” This is called “push-crash-burn” or “boom-bust” in the pain management world.
All of these activity patterns lead to gradual worsening of symptoms, and reduction in function, over time. You find yourself able to do less and less as time goes on, and pain gets more and more limiting.
This is where a technique called pacing comes in. Pacing, simply put, is doing what you can do consistently, without causing a pain flare. It is finding the middle ground between doing nothing and doing too much. Pacing will increase fitness and stamina, reduce depression and boredom, and reduce the risk of injury. It sounds easy, but it does mean you need to pay attention to what you are doing, how long you are doing it, and what you are feeling.
There is a lot of research out there to support the use of pacing. It has been called the most effective way to improve quality of life in people with chronic pain – more than any other form of treatment, including medications. There is no copay, no special equipment, no appointments to keep, no nasty side effects. It’s just you, a clock, a pencil and paper, and the willingness to pay attention.
Pacing means using TIME to decide when to stop an activity, not pain. You will need to keep track of how long you are usually able to do an activity on good days and bad days. Once you have an idea, limit how long you do that activity to a little more than you can do on bad days, and less than you are able to do on good days. Alternate periods of activity with periods of rest. By doing a little less than the maximum, and avoiding starting flare, your rest/recovery time will be less, and you’ll be able to do more overall.
So, say an activity that increases your pain is washing the dishes. Start by keeping track of how long you can wash dishes comfortably on a couple of good days, and a couple of bad days. Write it down, then average it (add up all the times and divide by the number of times you kept track).
|Day 1||Day 2||Day 3||Day 4||Day 5||Average|
|4 minutes||3 minutes||7 minutes||9 minutes||5 minutes||5.6 minutes|
The average is 4 + 3 + 7 + 9 + 5 divided by 5 (the number of days). Now figure out 80% of the average (5.6 minutes divided by 0.8 equals 4.5 minutes). Start by washing dishes for 4 and a half minutes, then rest for at least half of that time, then wash dishes for 4 and a half minutes, then rest, then wash dishes, etc. Use a timer. DON’T CHEAT and go longer on good days! Remember, the idea is to prevent a flare due to over-exertion. Every 3-4 days, try to increase the activity period by 10-20%. If you are having a bad day, reduce your activity period to half, then increase back to the full time over the next 3 days.
This technique can work for any activity – sitting, walking, standing, cooking, reading, exercising. Rest periods can be whatever is restful and restorative for you – reading a book, listening to music, texting a friend, meditating.
For more information:
- Improve Your Function Through Effective Pacing
- Pacing for Pain
- The Princess In the Tower: a website with information on healing, soothing, calming, and pacing strategies for managing pain. Blog entry on pacing for pain management read here.
At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.