Using Pacing to Overcome Effects of Pain

A common story from children with activity related pain is that they push themselves until they feel the pain tells them to stop. Then they rest, possibly take pain relief, and wait for the pain to ease.

After a period of rest the pain may ease a little and then they will get up and try again - only to find the same thing happening all over again. After repeating this pattern over and over, they may also start to get frustrated at not being able to do many of the things they used to do quite easily. Eventually this can lead to feeling that the pain is controlling their life.

The diagram below shows a common picture many people with chronic pain report.

Each episode of increased pain makes it more tempting to avoid taking part in activities that result in more pain. Over time, reduced activity (excessive rest) will cause the body to lose condition, with joints becoming stiffer and muscles becoming weaker.

As your body loses condition it will gradually become less able to cope with a higher level of activity. Over time, less and less activity will be needed to overdo things. Rest or low activity period tends to become longer and total daily activity tends to become less and less.

The effects of inactivity on our bodies

In a surprisingly short period of time too much rest can have marked effects on our body which can include, loss of muscle strength, joint stiffness, reduced bone strength, increased tiredness and fatigue.

Other drawbacks to the cycle can include:

• fare-ups in pain severity (which can last for hours to days).
• the pain decides how much you do, not you (you don't feel in control of your daily life).
• life becomes difficult to plan ahead because the pain might play up.
• difficulty in joining in activities in school and homes.
• you can start to feel that you are never getting anywhere (and end up with feelings of frustration, failure and even sad).

Why children remain in this activity/pain/rest cycle

Whilst most children say they can see this pattern of activity is not getting them anywhere they find it hard to get out of. After all, they can see how important it is to keep active and to lead as normal life as possible - it's just that each time they try, the pain stops them.

Some children say they can't stop because they have no choice (for example to keep up at school or home). Others say such things as "it feels better to finish things" or "activity is often enjoyable, and it helps to distract me from the pain".

The first step is to realise that you are in this cycle. Then you should try to work out why you do it.

Perhaps some of the reasons mentioned above will be familiar to you? Whatever the case, there are ways to increase your activity level without stirring up the pain too much so that you can once again enjoy a wide range of activities.

Naturally, some activities will take longer to achieve than others. Realistically, you may have to accept that some are impossible. In these cases, you will need to look for alternative options or decide on your order of priorities. For example; if you can't do everything you would like to do, then which activities can you drop for now?

Remember, you may be able to get back to them at a later stage.

Pacing: an essential technique for mastering your pain

The aim of pacing is to maintain a fairly even level of activity over the day. There are three main aspects of pacing.

Take frequent, short breaks

Do something for a set time, then take a short break, then do a bit more, then take another short break, and so on. For example, if you can mange 15 minutes in the playground, but then have to rest for the rest of the day, try playing in the playground for 10 minutes, take a break, before playing some more. This way you will do less than you could do each time, but you won't overdo things and ruin your whole day.

Gradually increase the amount you do

To "pace up" an activity you should plan to do a bit more each day, or every second day. Each increase should be small and you should not do more than you planned, even if you feel like it. Before long, you will be able to do more than before, and without the extra pain you used to get.

To continue with the playground example mentioned above, you would work out how much more you could do each day. You may decide to add on one minute more to each session. If so, on the first day you would do a 10 minute sessions. On the second day, an 11 minute sessions, and so on. In this step by step way you can slowly increase the time you spend in the playground without overdoing things.

The three ways of pacing can be applied separately, but they will often overlap. Pacing should be applied to both exercises and daily activities such as sitting, standing or walking, school clubs and after school activities.

The following steps to pacing should be followed whatever the task:

1 Work out what you can manage now

Once you have decided which activity or exercise you want to build up, work out what you can do comfortably now without too much extra pain. Do not compare yourself with what you think you ought to be able to do - you are trying to work out what you can do now, not at some other time.

2 Work out your starting point or baseline

To make success more likely, don't start pacing up from your current level because it may reflect a good patch.

Instead, start just below it, at a level you know you can manage. A starting point 20 per cent below your current level is usually suggested. If you are not sure how to work out 20 per cent, just reduce your current level by enough to be sure that you will succeed the first time you try the exercise or task.

Using the playground example again, you would set your starting point 20 per cent below the 15 minutes you normally spend in the playground at one time. This means you would start at 12 minutes.

3 Decide on a realistic build up rate

Most people want to run before they can walk, but you will already know that trying to do too much too soon will make you overdo things. Before long you would be back to square one. You will be more successful if you try to build up your exercise or task slowly to begin with. Later, if you think you could go faster, you can give that a try.

But first, build up slowly, then see how things are going.

You should try to build up your exercise or task at a steady rate, regardless of the pain. So, when you are figuring out your build-up rate, ask yourself "Will I be able to do that much when the pain is bad?" If you are too optimistic to begin with, and you set too high a build-up rate, you can change it. But you will find it helps your confidence more if you set a rate you can keep. Using the playground example, you might decide you could manage to spend an extra minute in the playground each day. If you started at 12 minutes on day one, on day two you would do 13 minutes, on day three 14 minutes and so on.

4 Write your plan down and record your progress

Trying to keep your pacing in your head will probably result in confusion and forgetfulness. You will find it helpful to write your plan down and to record your daily progress. In this way you will soon notice if you are making progress, or slipping back. Signs of progress will usually be gratifying and confidence building. You might even give yourself a special reward when you reach your goals each week. Signs that you are slipping or not progressing will give you a chance to work out why and what you can do about it.

Start on activities that are easier. Once you have learnt how to manage them, you will find it easier to tackle the harder activities. Be prepared to leave those activities that are too hard for now. You can come
back to them later as you get fitter.

2. For those activities that you cannot leave, it is important that you still try to pace yourself as
much as possible. Take short rest breaks as often as possible (stretch and relaxation exercises are
helpful things to do when you have a rest).

3. Remember, it is all right to ask for help with specific tasks now and then - everybody does it.
People who feel unable to help you with your pain may be glad to be asked to do something they can do to help you.

4. Keep to your targets and plans as much as possible. This will mean that you and not your pain will decide how much you do. If you are having a bad day, try and keep going as you have planned but pace yourself more (that is, take more rest breaks). If you are having a good day, be careful not to do more than you have planned, to avoid over doing things.

If you follow these guidelines you should have fewer flare ups with your pain and you should gradually find yourself doing more and more. As the next diagram shows, this approach means doing more on the bad days but less on the good days, so that you avoid overdoing things. Naturally, this all takes quite a lot of discipline on your part. But it will be worth it in the end (which is why it helps to select goals which mean something to you).

As you would expect, progress in this area is rarely "plain sailing". Setbacks or flare ups will happen from time to time no matter how careful you are.

How far should you go?

This is really up to you. In the end, it depends on what you are trying to achieve. For most people, simply
achieving a reasonably balanced lifestyle, between exercise, leisure, school, and family or friends is enough.

Others want to excel at something. But there is no point in simply getting fitter unless it is leading you
somewhere. That is why working on your goals is critical.