Pacing For Chronic Pain
By Mara Towne, PT, DPT
“Every flower blooms at its own pace.” -Suzy Kassem
Pace yourself! We’ve all heard this but what does it mean? How do you know when you are doing too much?
Patients who have been living with chronic pain are likely familiar with the “boom/bust” cycle. You feel great one day, so you decide to do 8 loads of laundry, clean your entire house and walk the dog. But the next day you can’t even get out of bed! It’s hard to break this cycle! Nevertheless, it’s important to find a balance.
The first step is to identify your goals. For example, let’s say you want to walk for an hour. You need to break this task down into more manageable steps. To do this, you need to have an awareness of what your baseline is. How long can you walk prior to having a pain flare? If you are not sure how to answer this, your physical therapist can help you identify your baseline. For this example, let’s say your baseline is 10 minutes. This is where you start. On day 1 you will walk 10 minutes. A lot of research will tell you to then add 30-60 seconds every day. However, you need to reflect on what is feasible for you! Are you going to be able to walk every day? We want to set realistic goals so we can succeed!
We often have patients start out with 3 activity days a week. That way you can space out your activity days. Day 1 you will walk 10 minutes. On day 2 you will rest and also monitor how you feel. You will probably be a little sore and may have a slight increase in pain the next day. This is typical muscle soreness. But, if you are unable to do your daily activities, then 10 minutes might be too much for your baseline. There is a little bit of trial and error in this process, so please don’t get discouraged! Pain flares can happen but if you are mindful about your activities, then you can get back on track!
The next activity day try to increase your walking by 30-60 seconds. How do you feel? Remember this is about gradually increasing your activity. If you are feeling really good on the next activity day, that does not mean you should walk 15 minutes. This is how we get into the aforementioned “boom/bust” cycle. It’s a marathon, not a sprint! Continue to gradually increase your time that you walk by 30-60 seconds on each activity day. If you have a pain flare, then decrease your time to add only 15 seconds and see how you feel after that.
Sometimes worksheets can be helpful. This website from NHS Oxford University Hospitals (https://www.ouh.nhs.uk/patient-guide/leaflets/files/11850Ppacing.pdf) has worksheets with examples to help you to find your baseline and increase your activity from there.
If you have any questions or concerns we are always here to help!
Mara Towne PT, DPT
NHS: Oxford University Hospitals: https://www.ouh.nhs.uk/patient-guide/leaflets/files/11850Ppacing.pdf
K Jamieson-Lega, R Berry, CA Brown. Pacing: A concept analysis of a chronic pain intervention. Pain Res Manag 2013;18(4):207-213.