If you are living with persistent/chronic pain and you have sought advice from a professional who is knowledgeable about chronic pain, they are highly likely to have advised you to pace your activity. Pacing activity is understood to be a key-way to manage chronic pain and can aid recovery by helping the person to avoid pain flare-ups.
Pacing my activity has been intrinsic to my recovery from chronic pain. I used it as part of my rehabilitation to recover from my first episode and I am currently using it to aid my recovery from my pelvic pain. However, despite the fact I’ve been practicing it for many years, it doesn’t make it any easier to do.
It’s only recently that I’ve truly realised the real reason I find pacing so difficult to do and to maintain. Every day I try to make the best out of my day. For me, that means being active and getting lots of things done in a day, which isn’t reflective of what you are meant to do when pacing activity.
I’m well used to my family telling me that I’m trying to do too much and Pete getting exasperated with me as I try to do things when actually I need to go and sit down and rest.
It wasn’t until I was listening to a podcast that I regularly listen to, which always ends with a guy in a cheesy American accent saying ‘I hope you make the best out of your day’, that I thought, that’s what I try to do every day. And for me, making the best out of a day means exercising and getting stuff done, every single day. This has always been important to me and always will be, which is why I struggle so much with pacing. I wish this wasn’t the case, as I’m fairly sure it would have made my recovery easier and quicker if I could chill out a bit.
I’m no different to anyone else. We all want to make the most out of the day, no one wakes up and thinks ‘I want to have a really crap or an average day today’. But everyone has different opinions on what qualifies as a ‘good day’ or what constitutes to ‘making the most out of a day’. For many people making the most, doesn’t involve being ‘on the go’ all day but for most people it does include some level of activity.
When you have chronic pain, even doing very normal activities in the day such as housework, shopping, going out with friends or walking the dog can be utterly exhausting. Sometimes just getting out of bed is impossible. So making the most out of your day, whatever that may be for you, can be really difficult.
Why pace your activity when you have pain?
Chronic pain sufferers tend to overdo things on ‘good days’ when they are feeling good and their pain or symptoms are lower. The fatigue of overdoing it causes a flare-up of pain, resulting in a ‘bad day’ and means the person then has to rest to recover. This causes a boom-bust cycle, which if it continues, means that the person fatigues quicker and each time can take them longer to recover from the flare-up.
This can be a slippery slope, as longer rest periods can mean the persons activity decreases, as does their fitness. They may start to believe they can’t do the activity or that they should avoid it all together, because it’s going to hurt and therefore be harmful to their body. The fear of pain can then become more disabling than the pain itself.
This certainly was part of my problem and contributed to me going from being an extremely active person to eventually avoiding riding horses, running, gym work, house work, carrying heavy objects and eventually, at times, not even being able to manage a fifteen minute walk.
How to pace your activity
The whole point of pacing is to keep an even level of activity throughout each day so you don’t overdo it and in-turn trigger your pain. I’m obviously not a professional, I am merely sharing what I’ve learnt along my very long journey with chronic pain but I know it’s very important to get to know your capacity.
Understand your capacity
Your capacity is all about what you can comfortably achieve before feeling your pain increase. You can still undertake activity but you need to stop before you get to the point of feeling tired or before the pain sets in. Ideally you should stop before you even get close to that point. You need to understand what your capacity is and remain within it. Don’t base it on what you used to be able to do before you had the pain or what other people are achieving. This is about you and your body.
When I have done too much, I can feel my body start to fatigue and ache, then the pain creeps in and I know if I can carry on with what I’m doing, the pain will only escalate.
You need to be realistic and not push yourself too much. It’s probably a good idea to start with a slightly lower level of activity to ensure you don’t misjudge it and exceed your capacity. If you struggle to find your capacity it’s a good idea to get a physiotherapist who understands pain management, to help you work through this.
If your pain is constant and you are thinking “what the hell is she talking about, I’m always in pain so I can’t even start to find out what my capacity is”. Trust me I’ve been in this position and this is when you need an expert in pain management to help you establish this.
Take regular breaks
A big part of pacing is to take regular breaks. This is what helps to avoid those flare-ups as it gives your body time to rest and recover. This increases your capacity again, allowing you to carry on with some further activity, as opposed to completely burning yourself out and then having to completely rest due to the level of pain you are in.
Do something for a short time and stop plenty before your limit, then take a short break, then do a bit more before taking another short break and so on.
For example, if you normally do 30 minutes of housework, but then have to lie down for a few hours due to fatigue or pain, try doing 15 minutes of housework, taking a 15-30 minute break, and then continuing for another 15 minutes. This way you will have still achieved the same total amount of housework, but you will not have over-done things and ruined your whole day. A rest can include sitting or doing a relaxation activity such deep breathing or meditation, rather than necessarily going to sleep.
I use pacing every day. I have to pace everything including, exercise, cleaning, gardening, shopping, I even have to pace the time spent on my mobile phone, otherwise my neck flares-up.
When I’m baking I’ll often get all the ingredients out so they are ready, then I will have a rest. I’ll then bake the actual cake and if there is a need to make any frosting, icing or further decorating, I’ll do that part later, after I’ve had another rest. If I’m struggling, I will sit on a bar stool and try to do most of the baking sitting down.
You can also try breaking up bigger tasks over a few days, rather than trying to achieve it all in one day. It can help to keep a daily record of your activity so if you are struggling, you can look back and take stock to see if there is a pattern to what may be causing it. Also, over time, a record can be useful to look back on, to show you that you have progressed.
It’s good to have goals as part of pacing your activity so you have something to aim for but it’s also important that they are realistic and you don’t push yourself to achieve them before you are ready.
Pacing was not the only thing that helped me recover from my first episode of chronic pain but it was a massive part of it. As detailed in a previous blog, I went from having constant 24 hour pain in my back, neck and head and barely being able to any exercise, to getting back to being fully active. It’s also been intrinsic in aiding my current recovery from pelvic pain. Without pacing and setting goals, I wouldn’t have gone from not being able to walk for five minutes down the road without feeling pain, to doing the couch to 5k programme.
Finding your capacity and remaining in it, is incredibly tricky. It will probably take you a while to define it and you are likely to have several times when you push yourself beyond it by mistake. For example, you may have ended up on a longer walk than you had intended but you had no other option than to finish that walk. Or your child is being particularly demanding, but you can’t just leave them so you have to carry on and push yourself that little bit too far.
If you stick to pacing your activity, very gradually, over time, your capacity will increase and you will slowly be able to do more. You probably won’t even realise it at first and then you’ll suddenly look back and think ‘oh yeah I couldn’t have done that three months ago’. You will start to feel when your capacity has increased and naturally be able to do more, making you become more confident in your capabilities and boundaries.
Yet as tempting as it is, it’s vitally important that as things progress and you are able to do more, that you don’t throw pacing out of the window and think you can return to do all the things you used to do. Pacing needs to remain as part of your daily management of your pain. For some people it will help aid their recovery and for others they will need to practice it for years or perhaps forever, just to manage their pain.
Why it can be so difficult to pace your activity
It’s all very well me saying this but I don’t always practice what I preach! Pacing is bloody difficult and massively frustrating and I have always struggled with it, as I just always want to be on-the-go. Exercise, baking, housework, gardening, shopping, walking the dog and looking after a child, I want to do it all.
Here are a few of the reasons I often give to Pete when I’ve reached my capacity and he is trying to tell me to go and rest but I’m arguing that I need to carry on:
“There are loads of things that need doing around the house”
“I felt ok when I started it”
“I just want to achieve something”
“I can’t stand to see it not done”“It’s not fair on you, having to do everything”
“I’ve hardly done anything today”
“I don’t know when I’ll get another good day, so I try and do as much as I can”
“It’s just so frustrating!”
“I feel lazy”
As frustrating as it is, in reality, these reasons are not significant enough to overdo it and cause a pain flare-up and potentially jeopardise my long-term recovery. I can’t emphasise enough, how important it is to be realistic and realise when you have done enough and to avoid pushing yourself beyond your limit.
You may have to lean heavily on family or even friends for support. They may have to help you with housework or shopping or provide emotional support. Pete will often tell me that I have reached my capacity and to go and sit down before I will let myself. This isn’t good, as it means he can tell by my already fatigued look that I’m struggling, which means by that point I’ve already done too much.
Exercising when you have pain can help
What makes pacing even more difficult to understand, is that sometimes you have to exercise when you have pain. Let’s face it, if you didn’t, sometimes it would mean that you never exercised as the pain can be constant for some people. But it’s not necessarily always a bad thing to exercise when you are in pain. It’s all about finding the balance. I find that when I am rested but still feeling pain, then it’s ok to exercise.
Let me explain…in the mornings I often wake up in pain. Having a baby and living with chronic pain means getting eight hours sleep is very rare, but these days I normally get at least a good few hours straight. So physically my body is rested but some days I will still wake up with a lot of pain. At weekends I normally do my exercise first thing in the morning, whether that’s going for a dog walk or going for a run or spin.
When I’m in a lot of pain, my debate in this situation is, do I do the exercise and risk the pain getting worse or do I rest? Nine times out of ten, I’ve found it’s better to go for the walk or do the exercise as I always feel better after doing it. The exercise gets the muscles working, adrenaline pumping and the endorphins help to lift my mood. It also eases my anxiety about getting exercise to burn some calories.
When I am rested but in pain, exercise doesn’t increase my pain levels or cause a flare up. It won’t necessarily decrease my pain but at least I will have done some exercise and not be in any greater pain. And sometimes the pain does decrease.
There are of course a few exceptions to this rule. If I wasn’t fully rested and I was feeling pain because I’d already done a lot, then more exercise wouldn’t be a good idea. Also if my pain has been constantly high for several days in a row, then it’s normally because I haven’t paced enough and I need to slow down. It’s all about finding your own balance and being in tune with your body.
It’s not easy to find the balance and I get hugely frustrated and angry about having to rest. If I don’t relent, I will get to the end of the day and crash, with high pain levels which will also be bad the next day. It will often cause me and Pete to have a few cross words as I’m often not good at resigning myself to the rest period. Yet I admit (through gritted teeth), when you have chronic pain, pacing your activity is the only way to achieve daily tasks and to manage your pain and is a key requirement for long-term recovery from pain.
There’s also no denying that a day without a pain flare-up makes for a much better day and despite it being hugely frustrating, what I’ve come to realise is that pacing my activity helps me make the best out of my day, in more ways than one!