Pacing and Chronic Pain

If you have had chronic pain for a while you will no doubt have lost some physical fitness and may struggle to manage everyday tasks. A really important part of managing chronic lower back pain is to increase activity levels without flaring up your pain symptoms and without causing a rebound drop off in activity from too much soreness. It's a question of balancing your rest and activity time so you have a better quality of life.

Many chronic lower back pain sufferers are less active than they used to be. You may have noticed yourself trapped in a cycle of ‘boom and bust’ with activity and exercise.

Examples of Pacing problems

A good example of this is someone who has pain that interferes with normal day to day activities. They wake up one day and feel they are having a ‘good day’ and so decide to mow the lawn, and go for a walk while it feels OK.

Later that evening the symptoms are worse, they feel they overdid it and decide to take it really easy for a few days. Eventually it settles and the pattern is repeated again when they feel a bit better.

Another pacing problem is around those day to day chores that need to be done. These are the normal Jobs at work and home that build up around us. If there is a day when you feel better the the temptation is to try and do everything all at once because you don't know when the next opportunity will be.

A third approach is the 'never give in' attitude. Refusing to let the pain beat you and stop you from doing what you want and need to do. This is when it feels you are at war with your pain and you are not going to let it win.

With all these ways of approaching activity the activity may be followed by more pain and for some more inactivity follows as you try and settle it down – ‘boom and bust’. Your baseline level of fitness never really improves – if anything it gets worse. Repeated flare ups of pain lead to more feelings of loss of control, anxiety and isolation.The cycle of chronic pain continues.

a graph showing how activity pacing in chronic pain can help you gradually build up your activity levels without flaring up your pain

In order to overcome this it is important to use pacing skills to determine how much activity is the right amount for you to start with – it may be a very small amount initially. One of the things that surprised me about this when I started studying it was how little you need to do to start with to get good results. The key thing is that you build on small amounts – if you take it steady you can do some more the next day. Each small step leads you in the right direction – upwards towards a better quality of life.

You need to start by establishing a baseline – let’s say for example you want to increase the amount of walking you do.   Think about how far you can walk now without a flare up? Is it five minutes? If so you begin by doing slightly less than that - the aim is to stop short of an aggravating flare up. Keep a diary and aim to build up very slightly week by week, plan to gradually increase it over many weeks.

Pacing takes patience though, you have to be very calm and kind to yourself throughout.

Set yourself some goals – say for example being able to walk to the local shop (10 minutes walk) in a month. Plan your progression to aim for this and remember that you have plenty of time to reach your goals.

Chronic pain is complex - expect the odd setback. Its rare that someone follows a perfect line like the picture above, usually there are peaks and troughs but as long as the overall movement is upwards then that's fine. Eventually you will find that you can achieve a lot more in your daily life.

If you are struggling a lot with chronic pain and pacing and feel you cannot exercise because of it you should seek specialist support from a chronic pain management programme that will help you pace and improve your daily activity levels.

References and Resources

This is a very helpful pacing sheet from Psychology Tools:

An excellent book that really does Explain Pain:

Butler, Moseley. Explain Pain. NOI Group Publications,Adelaide, Australia 2003

Lower Back Pain Toolkit Home Page

Acute versus Chronic Pain - What is the difference?