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Chronic Pain

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It is not uncommon for people who experience chronic pain to stop doing activities that cause them more pain, or put them at risk of re-injury. There is a feeling that, with rest, one will get better and be able to get back to doing normal activities again. Yet, when pain persists, the lack of doing activities (be they self-care activities, domestic chores or social activities) can make people feel de-motivated and can actually result in a weakening or stiffening of muscles, like a de-conditioning effect. If you think that such a scenario sounds like your situation, you might want to consider using a technique called pacing. Pacing is a technique that can help you to do the things that you want to do during your day/week by engaging in small amounts of the activity over the period of time available to you. It is like the opposite to going all out to do an activity that you want to do, such as mowing the lawn or doing the Christmas shopping all at one, where you end up feeling in so much pain you vow you will never mow/shop again.

Here's the technique with selected activities:

Pacing technique involves determining the level of an activity that you can do on a bad day, then practising 80% of that level whether you are having a good OR bad day. You do this for a few days, then increase by a small amount. Before learning how to pace, people in pain often stop doing things on bad days. When they are feeling better they will do as much as they can before experiencing pain, then stop. This is referred to as a Boom-Bust pattern. This gradual increase method practised daily allows you to succeed in gradually improving your tolerance to an activity – in the boom/bust pattern you can’t. Learning good pacing technique takes the threat out of activity and can have a really amazing effect on brain pathways. 

Think big picture

The first step to using pacing in your life is to plan what jobs or activities are important to you that you want and/or need to do. Then, look at the time that you have during the day/week, what other activities you have to do, and scheduling times when you can do the activities in small steps. The steps you can use to successfully pace are:

  1. Plan the activities that you want to do. It is helpful to write a list of the things you want to do, both in the short -term and the long -term. These doing things can be things like taking to the grandchildren to an event, doing the washing, or going out to dinner.
  2. Look at the amount of time that you have available to do these activities. For example, the outing with the grandchildren could take place during the 14 days of their upcoming school holidays. Write down all the other activities you need to do during this timeframe.
  3. Then make a plan of when you will do the activities. Try not to bunch too many activities together. So, for example, plan to do the grocery shopping and the visits to Medicare and the optometrist the week after you do the outing with the grandkids. The day before the outing, plan for a less taxing day, so that you are fresh on the morning of the outing.
  4. Then plan how you can do the activity, in this case, the outing with the grandchildren, while building in frequent but small rest-breaks. If, for example, the outing is a visit to a theme park, plan on taking public transport there, so you do not have the added burden of driving. Pre-visit, plan the amount of time you will spend at the theme park with the children. Then, consider what rides the children want to go on, where they are in the theme park, and where are the facilities for resting (seating, cafes) in between rides. Agree on a plan with the children before you leave home, regarding time spent there, and your approximate schedule.
    Go and do the activity, and enjoy doing it.
  5. When the activity is over, review how you went. Did you have fun? How did your planning work out for you? How did you feel afterwards? What positive feedback did you get from others?

Now, perhaps this does not sound very fancy to you. It is, after all, not rocket science. But is does help you to get over the "I can't do anything" feeling, or the "boom and bust" syndrome. One of the toughest things about pacing is that it requires you to decide which things you want to and/or need to do, and then to plan how you are going to do them. In some ways, it makes life less spontaneous. But, many people have found that it helps them to get on with their lives and to feel good about their lives, while they continue to live with chronic pain.

Getting help

There are health professionals who can assist you with queries that you have regarding pacing, such as your GP, occupational therapist, physiotherapist or psychologist. One of the things about our lives and the activities that we want and need to do is that they do not occur in a laboratory. So, doing something like the shopping introduces potential environmental obstacles that sometimes need to be overcome. Sometimes it helps you to plan, brainstorm and problem solve strategies with someone who has done this before with other people.

Useful reading

Strong, J., Unruh, A., Wright A., & Baxter GD (2002). Pain: a textbook for therapists, Elsevier, Edinburgh. (Chapter 15).

This article is written by Prof Jenny Strong and Dr Coralie Wales

Chronic Pain Australia

Sometimes the journey TAKES YOU TO A PLACE UNMAPPED. Anything is possible

-Chronic Pain Australia

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