Pacing to manage persistent pain

Persistent pain symptoms usually lead to changes in activity levels. Some individuals tend to avoid engaging in normal activities as a means of avoiding pain flare ups. Other individuals push through their pain symptoms to get tasks completed, only to experience increased pain and subsequent inability to complete further activity until the pain decreases. Both of these approaches can have a detrimental effect on quality of life, feelings of control over pain symptoms and long-term engagement in meaningful daily activities.

Too much rest

Adequate rest from physical activities is important to assist with moderating pain levels and allowing for tissue recovery, however too much rest can be harmful to our long-term health and wellbeing. The effects of too much rest include:

  • Increased risk of heart disease
  • Obesity
  • Weakness of bones and muscle wastage
  • Premature ageing
  • Mood changes, such as depression

The above points highlight the importance of maximising engagement in meaningful physical activities such as a structured exercise program, household tasks, and socialising with friends and at work to assist with maintaining our overall health and wellbeing to counteract the above. But how do we do this, when activity leads to pain?

Pacing is a way in which we can take a ‘time focused’ rather than ‘pain focused’ approach to activity, which means engaging in an activity for a certain amount of time and then ceasing it before our pain increases. Pacing allows us to undertake a little bit of activity often, to ensure our activity levels are constant across a day or week; rather than a ‘boom-busting’ approach (doing a lot and then needing prolonged rest).


Benefits of Pacing

  • It allows us to engage in more meaningful activities that are important to us
  • Helps to reduce the frequency and severity of pain flare ups
  • It gives us control of our lives regardless of persistent pain

How to pace

1

Think about what tasks are important to you. What can you comfortably do now and what would you like to be able to do? Your Exercise Physiologist can assist with setting achievable ‘stepped’ goals to assist you to re-engage with meaningful activities.

2

Discuss this with your Exercise Physiologist, who can assist you with determining your baseline activity tolerances and provide you with a graded plan to increase your activity alongside your exercise program. This could be gradually increasing the time or distance achieved within an activity, or alternating heavy/ stressful activities with lighter/ easier activities.

3

Keep a record, such as an activity journal, to monitor your progress and keep track of what is being changed. To ensure good pacing, it is important to only change one to two components at a time.

4

Make sure that on ‘good’ days, you do no more than your pacing schedule allows and on ‘bad’ days, you still try to do something, even if it’s at a lesser amount.

5

Having a flare up is okay! It just means we need to go back a step when we start our activity again. Go back to what is achievable for you and gradually pace your activity level  up again.

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References:

Australian Pain Management Association (2018) Pacing Activity Retrieved 3rd April 2020 from https://www.painmanagement.org.au/2014-09-11-13-35-53/2014-09-11-13-36-47/166-pacing.html

Nicholas M, Molloy A, Tonkin L, Beeston L (2012). Using Pacing to Overcome the Effects of Chronic Pain on Activities in Manage your pain: Practical and Positive Ways of Adapting to Chronic Pain.

Nielson W, Jensen M, Kardorp P, Vlaeyen J (2013) Activity Pacing in Chronic Pain Concepts, Evidence, and Future Directions. Clinical Journal of Pain

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