Chronic Pain – Part 2: Pain & Pacing

Chronic pain naturally creates changes to our daily habits and activities. We are forced to give up some activities entirely, while reducing the intensity of others. As pain ebbs and flows day to day, and hour to hour, we risk falling into the ‘overactivity/underactivity cycle’ (Nicholas et al, 2011), visualised below: (Image from https://publicism.info/self_help/pain/9.html) On […]

Chronic pain naturally creates changes to our daily habits and activities.

We are forced to give up some activities entirely, while reducing the intensity of others.

As pain ebbs and flows day to day, and hour to hour, we risk falling into the ‘overactivity/underactivity cycle’ (Nicholas et al, 2011), visualised below:

overactivity-underactivity cycle

(Image from https://publicism.info/self_help/pain/9.html)

On a good day, we try to play catch up and become overactive, causing a heightened pain response, leading to increased rest and underactivity while the pain eases.

This cycle is mentally and physically draining, and can lead to physical deterioration as our body swings between peak activity, or none. According to Nicholas et. al (2011), even short periods of inactivity can lead to:

  • An increased risk of heart conditions
  • Obesity
  • Weakness of bones
  • Muscle wasting
  • Depression

The key to breaking this cycle is pacing: sustaining a moderate level of activity throughout each day.

Here are some tips for how to build pacing into your day, and break the burnout-inactivity cycle.

1. Divide big tasks into smaller ones

If you want to clean the house, do it room by room, and spread it out over a couple of days, instead of trying to do it all at once. 

If you do a weekly shop, and need to carry heavy bags as a result, consider bi-weekly shopping trips to lessen the load.

2. A few small wins

“George Washington’s favorite saying was “many mickles make a muckle.” It was an old Scottish proverb that illustrates a truth we all know: things add up. Even little ones. Even at the pace of one per day.” – Ryan Holiday

Read another chapter of a book you love. Phone a friend to catch up. Cook a tasty breakfast. Small wins matter.

3. Write a list

Write a list each night of what you aim to do the next day. Not only will this help you sleep better, but ticking them off feels very rewarding.

It can also help you manage your activity expectations. Did you try to do too much, or too little? Test yourself and see.

4. Schedule small breaks throughout your day

 

Effective time management is pain management. Short, regular breaks will ensure you don’t overdo it on one task, leaving you drained for the rest of the day. 

If you spend 20 minutes baking, sit down for 30 minutes and relax. This way, you will end up doing more, with less risk of pain peaking. 

5. Try mindfulness

 

“Being able to focus on relaxing the body, noticing the breath and body sensations as being there just as they are, can help manage pain, as well as reduce depression and anxiety symptoms.” – Mayo Clinic

Mindfulness is proven to be effective in managing chronic pain. Take time out to practice this, and you will return to your day refreshed. 

Here is a 10 minute mindfulness video from Jon Kabat-Zinn, an expert on mindfulness for pain: https://www.youtube.com/watch?v=QCNXi_0lsCk 

6. Make a plan and record your progress

Make a note of your current activity levels to set a baseline, and decide on a plan – with help from a health professional – to gradually increase your activity. Record your progress. 

Having a plan to follow will keep you on track, flag any specific issues, and your incremental improvements will motivate you and boost your confidence.

As Plato put it: “Never discourage anyone…who continually makes progress, no matter how slow”

 

References:

‘Manage Your Pain’ (2011): https://www.amazon.co.uk/Manage-Your-Pain-Michael-Nicholas/dp/0285636790

‘A Few Small Wins’ https://ryanholiday.net/all-you-need-are-a-few-small-wins-every-day/ 

‘Mindfulness for Chronic Pain’ – https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/use-mindfulness-to-cope-with-chronic-pain 

‘Writing a To-Do List May Help Your Fall Asleep’ – https://psychcentral.com/news/2018/01/13/writing-a-to-do-list-may-help-you-fall-asleep/131170.html