Quick Guide To Pacing For Your CRPS & Persistent Pain
What is pacing? How does it help you with your CRPS, persistent pain or other chronic pain condition? How do you ‘pace‘?
When you hear the term ‘pacing’ most people don’t know or understand what is meant by it. People think that they don’t need to pace themselves to help them with their CRPS/RSD or chronic pain. But in fact it is very important to help you do things better despite your pain. Pacing is just 1 small part of helping you to self manage your CRPS or persistent pain.
Pacing can help you to take control of your condition and enable you to become an expert in managing your illness. What we mean when we say to pace yourself, is to not just put all your housework, jobs and activities in 1 part of the day, but arrange them throughout the whole day. So instead of trying to do all the housework in 1 hour of your day, try and do various elements of it over the whole day. This will give your body frequent rests so you won’t make your pain worse and body position changes so your muscles won’t clench up as much. Activity doesn’t necessarily mean physical activities but also mental and emotional activities as well.
PAIN AND FATIGUE CYCLE
The idea of pacing is to try and break the pattern of having less good days and more bad days because you have been pushing your body too much on those good days. You should be able to pace your way through any form of activity whether it is shopping, hanging out the washing, hoovering or dusting the house. When you start pacing your activities and jobs you have to do, you will find it hard but eventually you should begin to be able to do them for longer and longer each time. Set yourselves small goals and then increase them each day, but remembering that you can say No and ask for help!
Suffering with CRPS or a chronic pain condition means that on some days you can feel less pain and at other times your pain is worse or you’re in a flare. When chronic illness reduces your activity levels it is very easy to try to make up for lost time on better days. But cramming in too much activity on a day when you are feeling better often leads to a setback in your symptoms. It becomes a vicious circle or a Catch-22 situation. This is sometimes called ‘boom and bust’ or ‘activity cycling.’ (Pacing for people with M.E. booklet 2016)
Pacing gives you awareness of your own limitations which enables you positively to plan the way that you use your energy, maximising what you can do with it. Over time, when your condition stabilises, you can very gradually increase your activities to work towards recovery.
NICE defined pacing as:
“… energy management, with the aim of maximising cognitive and physical activity, while avoiding setbacks/relapses due to overexertion…..The keys to pacing are knowing when to stop and rest by listening to and understanding one’s own body, taking a flexible approach and staying within one’s limits; different people use different techniques to do this..”
Most people may think pacing activity is just common sense. However, managing activity with regard to CRPS and persistent pain is contradictory to the way you have lived prior to becoming unwell with CRPS or chronic pain. You are generally taught to push through the pain when times get hard, to not stop and keep going. However this sort of attitude does not work with CRPS or chronic pain. You need to learn to rest frequently to allow the body to recover energy. If you push past your limit or Activity Baseline your body sends out inflammatory responses. It is these inflammatory responses that cause you extra pain or indeed a pain Flare Up causing you agony over and above your normal pain levels for a few hours up to a few days.
In the study by Neilson, W.R. et al (2001) they defined pacing to include going slower, taking breaks, maintaining a steady pace and breaking tasks into manageable pieces. Although the concept of pacing often includes the notion of increased activity tolerance they viewed this as a consequence of pacing rather than as part of the construct itself. The 1st important point to learn is what your maximum you can do in any given day. Start writing a daily diary of your activities noting down the activity and the time it takes.
Self-management of your CRPS or chronic pain includes taking control of the balance of activity and rest, and learning how to communicate to other people about the balance that usually works best for you. This balancing out of activity and rest is sometimes called “energy management“, “activity management” or “pacing.”
Pacing is all about balancing your activity and rest to bring about more stability in your symptoms, and more importantly what you can manage every day. It also offers you an opportunity to control the consequences of your CRPS or chronic pain. Whilst it does take self-control and patience, the stability it brings will help you to take decisions about building up activity. (Action for M.E.2016)
How do I pace myself through an activity?
- Pick an activity that at the moment you find difficult to do and would like to be able to do for a longer amount of time, for example, sitting, walking the dog, housework, hobbies
- Give yourself a small goal to aim for, which could be an amount of time that you know you can comfortably succeed, for example if you can normally sit down on a chair for a few minutes pick that amount of time
- Try and do the activity every day if you can on both bad days and good days
- Over time attempt to build on the original amount of time you do the activity, but remember – Don’t carry on with the activity over the planned time!
- Keep a journal / diary and write down each time you spend doing your activity and you can see how much you’ve progressed over the time you’ve been doing your pacing activity. Check out our Pain Diary for CRPS template blog to help you keep a track of how your pain does.
- Use this method for all your activities and remember you can say ‘No’ to doing too much!
According to McCracken, L.M. & Samuel, V (2006) they recommend that a formal approach to pacing would require that they train patients in certain steady rates of activity, perhaps without extreme fluctuations. ‘Pacing’ is seen as a poorly understood concept for which there are no available measures (Nielson, W.R. et al. 2001)
Check out the painHEALTH video on pacing and goal setting below:
A website called February Stars for fibromyalgia is a great resource which includes 10 tips for pacing. Please visit their website to see these 10 tips for pacing – February Stars 2016
CITED RESOURCES / ARTICLES / STUDIES / RESEARCH
- Action for M.E. (2016) ‘How can I manage my symptoms by pacing and energy management?’ Action for M.E. website. 2016. Available from: <https://www.actionforme.org.uk/resources/questions-and-answers/how-can-i-manage-my-symptoms-by-pacing-and-energy-management/>
- Action for M.E. (2016) ‘Pacing for people with M.E. booklet (2016)‘ Available for download from: <https://www.actionforme.org.uk/uploads/pdfs/pacing-for-people-with-me-booklet.pdf>
- February Stars website (2016) ’10 Top Tips for Pacing with Fibromyalgia,’ February Stars website. 2016. Available from: <http://februarystars.co.uk/2015/05/10-top-tips-pacing-fibromyalgia/>
- Gill, J.R. & Brown, C.A. (2009) ‘A structured review of the evidence for pacing as a chronic pain intervention,’ European Journal of Pain. 2009. Vol 13(2), pp214–16.<https://www.ncbi.nlm.nih.gov/pubmed/18448368>
- Hardie, J. (2008) Forth Valley NHS Trust: ‘Chronic Pain – Self Help Guide,’ Moodjuice guide. Available from: <http://www.moodjuice.scot.nhs.uk/chronicpain.asp>
- Lega, K.J. et al. (2013) ‘Pacing: A concept analysis of a chronic pain intervention,’ Pain Research Management. 2013, Jul-Aug. Vol 18(4). pp 207–213. Full Text Available from: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812193/>
- McCracken, L.M. & Samuel, V. (2006) ‘The role of Avoidance, pacing, and other activity patterns in chronic pain,’ Pain. 2007 July, Vol 130 Issues 1-2 pp 119-125. Available from: <http://www.sciencedirect.com/science/article/pii/S0304395906006397> doi: 10.1016/j.pain.2006.11.016>
- McCracken, L.M. & Samuel, V. (2006) ‘The role of Avoidance, pacing, and other activity patterns in chronic pain,’ Pain. 2007 July, Vol 130 Issues 1-2 pp 119-125. FULL TEXT Available from: <http://220.127.116.11/Files/AlwaysOnLearning/2686role_of_avoidance_pacing_in_chron_pain_mccracken.pdf>
- ME/CFS Diary (2016) ‘Activity Pacing,’ ME/CFS diary website. Available from: <http://www.mecfsdiary.com/activity-pacing/>
- Moore, P. (2015) ‘Pain Toolkit 3: Pacing. Learn to pace yourself,’ YouTube. 2015, March 27. Available from: <https://www.youtube.com/watch?v=nPdfFzU2n3I>
- Nielson, W.R. et al. (2001) ‘An activity pacing scale for the chronic pain coping inventory: development in a sample of patients with Fibromyalgia syndrome,’ Pain 89. 2001. pp 111-115. FULL TEXT Available from: <http://publish.uwo.ca/~mhill2/pain01pdf.pdf>
- Williams, D.A.Dr., Carey, M.Dr. (2003) ‘Improve Your Functioning Through Effective Pacing,’ UMHS. Available from: <http://www.med.umich.edu/painresearch/patients/Pacing.pdf>
**Please remember that this is not supposed to be a replacement for your usual medication or treatment. Please contact your doctor or pain specialist before trying anything new or different to your usual regime. Burning Nights CRPS Support does not endorse any particular website, company or healthcare professional.**
Last Updated: 07/09/2017