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Navigating Chronic Pain Through Activity Pacing: A Step-by-Step Guide

Imagine you live with chronic pain, and one day, you wake up feeling much more comfortable than usual. It’s a rare moment of relief, and you’re tempted to maximize this day. Driven by a sense of urgency to compensate for lost time, you dive into a flurry of activities, dismissing your usual precautions.

However, this surge of activity soon takes its toll. The following day, the pain returns sharply, forcing you into a period of minimal activity as you cope with the consequences of overexertion. This cycle of pushing too hard on good days and retreating on bad ones, often referred to as the “boom and  bust” cycle of chronic pain, highlights the challenge of finding a sustainable balance in managing chronic pain.

Track athlete with performance anxiety preparing to run at the starting line

Living with chronic pain is a deeply personal journey that touches every aspect of life. But amidst this challenge lies a powerful strategy for balance and healing: activity pacing. This guide is your companion in transforming how you navigate daily life, offering steps to harmonize your activities with your unique pain experience, promising a brighter, more manageable future.

Step 1: Identifying Pain-Provoked Activity Avoidance

The journey begins with awareness and introspection. Chronic pain often leads individuals to instinctively avoid activities they fear will exacerbate their pain. The first step is to meticulously identify and list these activities, recognizing that avoidance can inadvertently contribute to a cycle of decreased physical fitness and increased pain sensitivity over time.

Actionable Strategy: Create a pain diary. Over the course of a week, jot down activities you avoid due to fear of pain. Note the specific reasons for avoidance and any emotions associated with these decisions. This record will provide a clear starting point for addressing and reintegrating these activities into your life.

Step 2: Establishing Baseline Levels of Pain Activation

Understanding one’s baseline pain activation levels is crucial. This involves engaging in the previously avoided activities to the point of significant, yet manageable, pain, weakness, or fatigue. It’s essential to record the duration, frequency, or intensity of the activity, alongside the pain and distress experienced, using a 0-10 rating scale. Repeating this process three times and averaging the scores provides a comprehensive baseline for each activity, laying the groundwork for personalized pacing strategies.

Actionable Strategy: Conduct a structured self-assessment. Choose one activity from your pain diary and engage in it, stopping the moment your pain becomes noticeable but manageable. Record the duration or intensity of the activity, alongside your pain and distress levels on a scale of 0-10. Repeat this with the same activity over three different days to find an average baseline.

Step 3: Developing an Activity Hierarchy

Armed with baseline scores, the next step is to create an activity hierarchy. This list, ordered by the level of pain or distress each activity causes, serves as a roadmap for gradually reintegrating these activities into daily life, starting from the least to the most challenging.

Actionable Strategy: With your baseline data, list your avoided activities in order from least to most painful/distressing. Use a simple spreadsheet or chart to visually organize this hierarchy, making it easier to track and plan your progression through these activities.

Step 4: Determining the Starting Point

A behavioral pacing program begins not at one’s maximum capacity but at a reduced level—typically half to two-thirds of the baseline level. This conservative approach helps prevent overexertion and the potential worsening of pain.

Actionable Strategy: Calculate your starting point using the baseline data. For instance, if your baseline for walking is 8 minutes before significant pain, reduce this by half to two-thirds to find your starting duration (4 to 5 minutes). This conservative approach ensures a gradual increase in activity without overexertion.

Step 5: Setting Target Goals

Goal-setting is instrumental in pacing. A realistic target might be to gradually double the initial baseline levels over a period, such as four weeks. This provides a clear objective and a sense of direction, encouraging progress without overwhelming the individual.

Actionable Strategy: Define specific, measurable, achievable, relevant, and time-bound (SMART) goals for each activity. For walking, a goal might be to increase the duration to 20 minutes over 4 weeks. Write these goals down and place them where you’ll see them daily to keep motivated.

Track athlete with performance anxiety preparing to run at the starting line

Step 6: Determining the Rate of Activity Increase

Incremental increases in activity are key to successful pacing. A detailed daily schedule helps manage these increments methodically—ensuring that each step towards the target goal is deliberate and measured. This structured approach fosters resilience and adaptability, allowing individuals to steadily enhance their capacity for activity.

Actionable Strategy: Develop a weekly plan that outlines incremental increases in activity. For the walking example, you might plan to add 5 minutes to your walking time every week. Use a calendar to schedule these increases and check them off as you complete them.

Step 7: Tracking Progress

Maintaining a log of activities, including their duration and intensity, offers invaluable insights into one’s progress. This record not only serves as a motivational tool but also as a means to objectively assess advancements and setbacks, enabling ongoing adjustments to the pacing strategy.

Actionable Strategy: Keep a detailed log of your activities, including the actual duration/intensity, pain levels, and any notes on how you felt during and after the activity. This log will be invaluable for monitoring your progress and making any necessary adjustments to your plan.

Step 8: Identifying and Avoiding Safety Behaviors

A crucial, yet often overlooked aspect of pacing, is recognizing and eliminating safety behaviors—those aids that people over-rely on out of fear of pain but that ultimately hinder recovery. Identifying these behaviors is a step towards confronting and overcoming the underlying fear of pain exacerbation.

Actionable Strategy: Reflect on any behaviors or tools you use to avoid pain but may limit your recovery (e.g., always sitting down to avoid standing pain). Challenge yourself to gradually reduce reliance on these behaviors for one activity at a time, noting any changes in your pain diary.

Step 9: Troubleshooting and Adjustments

Finally, it’s essential to remain flexible and responsive to one’s experiences. If progress stalls or if pain levels increase, it may be necessary to adjust the pacing strategy. This could involve temporarily eliminating the most challenging activities, reducing target levels, or seeking additional support.

Actionable Strategy: Regularly review your progress log and identify any activities where progress has stalled or pain has increased. Adjust your plan by scaling back the activity slightly, focusing on less challenging activities, or seeking additional support if necessary.

It is recommended to do this work with a qualified mental health professional (e.g., a Psychologist that specializes in Health or Rehabilitation Psychology) to receive evidence-based care alongside a physician and/or physiotherapist to carefully tailor this approach to your health condition.

Track athlete with performance anxiety preparing to run at the starting line

Activity pacing is more than a strategy; it’s a personalized journey towards empowerment. With patience and persistence, you can find a harmonious balance between activity and rest, opening the door to an enriched life despite chronic pain. Remember, this journey is yours to shape, with each step forward illuminating a path to a more vibrant, fulfilled life.

References

Tearnan, B. H. (2007). 10 simple solutions to chronic pain: How to stop pain from controlling your life. New Harbinger Publications.

Dr. Abid Azam

Dr. Abid Azam

Clinical Psychologist

Please note: this article is for informational purposes only, and is not intended as a substitute for therapy or advice from a qualified professional.