Pacing for pain management

Who this leaflet is for?

This information leaflet is for all patients with persistent pain who may benefit from structuring their activities to reduce it. Changing your activity depending upon how much pain you are feeling at the time is not very reliable and can result in frequent flare-up and an increased sensitivity of the (pain) nervous system. Remember, in persistent pain conditions, although pain is not normally a sign of injury, it can be our body’s way of telling us that we have overdone things.

What is pacing?

Pacing is about spending just enough time on an activity to get the most you can out of it. Some people carry on with physical activity until the pain forces them to stop. However, this is often too late and leads to increased pain signals and sensitivity of the (pain) nervous system.

Pacing means organising your time and tasks so that you can do roughly the same amount of activity every day. It is based on planning what you want to do, rather than simply responding to what you feel at the time.

Why do I need to try this?

People with persistent pain are often faced with a dilemma; they know that the more they do, the more they are likely to experience pain. So some people might make the choice to do nothing. Although this can make sense, it is not usually a good choice. Doing nothing leads to boredom and depression. This tends to make your experience of pain worse. In addition, doing nothing makes you less fit and means that, over time, even a little activity will lead to you feeling pain.

So how do I know when I am pacing?

There is no right or wrong amount of time for doing an activity. Knowing when to stop each activity is a matter of trial and error. Find out through experimenting to see what works best for you. Sometimes it can be helpful to keep a record of your experiments on yourself so that you can work out just what suits you best. As you progress, this will help you to lengthen out your paced times.

Here are a couple of examples:

• If you find that doing an hour in the garden, without stopping, is enough to give you a lot more pain, try taking a break after half an hour.
• If you find that doing half an hour of ironing leaves you with a lot more pain, then try taking a break every fifteen minutes.

I got so involved I forgot about the time

It is possible to become so involved in a particular task that you lose track of time and forget to take a break.

Here is an example:

• You might be working at a workbench where you need to bend over slightly. While giving this work your full attention, you may have little awareness of pain until you stop and straighten up again.

A structured pacing approach means knowing when to stop and take a break, and finding ways to remind you to do this.

What sort of reminders can I try?

• You might place a clock in view or even set an alarm to go off after a certain amount of time.
• You might be able to break the job into smaller tasks such as weeding one part of the garden at a time or vacuum cleaning one room at a time.
• You can even break up activities, such as watching TV, by getting up and taking a walk or having a stretch during the adverts.

What do you mean by take a break?

To make good use of a break, it is important to change your position or body posture and to do something which engages your attention. It is less helpful to stop and just do nothing. It can be useful to plan what you are going to do in your break.

Some examples are:

• Having a walk
• Do some stretching exercises
• Put on the radio
• Read the newspaper or do the crossword
• Make yourself a cup of tea or your favourite drink
• Do some relaxation

How long do I need to take a break for?

Knowing how long you need before you return to your previous activity is very much a matter of trial and error. Experiment and see what works best for you.

Some activities such as sitting watching television might need only short breaks while others such as digging the garden might need slightly longer breaks.

But I have so much to do?

To help you overcome natural barriers to change, think about prioritising the activities you need to do. Ask yourself what really needs to be done and also consider those activities you really enjoy doing. It is important to get a good balance between the things that need to be done and those activities that are interesting and pleasurable.

Pain is felt less intensely if we are happy and involved in activities that interest us.

Remember, it is important to pace yourself in order to make the most of your life and your body. You may not be able to do all the things that you did before you had pain (or, at least, not as quickly or as often) so make sure you prioritise.

Pacing yourself well requires good planning; decide when and how you are going to undertake the activities you have chosen to do.

Some things to consider:

• Make sure that the tasks and activities that are most demanding are not all done at once but are spread out.
• Give yourself a reasonable time to finish jobs and to take breaks between activities.
• Allow yourself enough time to achieve the activities and tasks that you have planned.

By successfully pacing, you will find that you begin to enjoy activities more, and you may gain satisfaction in having accomplished something that you have set out to do.

It feels that I may end up doing less?

Pacing should be a planned approach to increasing your level of activity. Once you have identified set times for undertaking tasks and activities that don’t make your pain worse you can start to plan when to:

• Increase the time you spend on an activity
• Increase the number of times you undertake an activity
• Decrease the time of a break taken during an activity

You will also need to consider when making your plan:

• When to start
• How much to increase by
• How often the increases might be
• When you will re measure

Again, it would be better to write this down and keep a record so that you can make sure the changes are positive.

Useful sites to aid your structured pacing:

Arthritis Society Canada Online Learning Resources (opens in a new tab) (printable and easy to fill in activity diary to help you identify patterns of over and under activity that may be impacting on your pain and or fatigue)