Pacing every day to live well with pain

Frances Cole is a retired GP and author of An Introduction to Living Well with Pain. Here she introduces the idea of pacing as a key skill to learn for overcoming chronic pain.

Everybody with persistent pain agrees that pacing is a really, really important and useful skill to learn. They say not knowing how to pace yourself means your day or activity is controlled by pain. Pacing or balancing activities help turn it the other way around.

So what is pacing?

Pacing is taking a break before pain, tiredness or exhaustion force you to stop your activities or task.

Many people feel their pain often controls their daily activities. They use pain to guide them so, on a ‘good’ day with less pain, they throw themselves into things to get as much done as possible. Then pain and tiredness increases and forces them to stop. It is like driving as far as possible without a fuel stop on a ‘feel good’ sunny day. Then you run out of fuel and the car needs to be rescued!

Often, when doing an activity, your body feels good for a while, less stiff, wants to keep going and not take a rest. This type of striving often pushes on into severe pain setbacks and forces you to rest for much longer.

This is called the ‘boom-and-bust cycle’ or ‘overactive and collapse trap’. It is useful for getting important things done for a crucial deadline like moving house. But it is an unhelpful thinking pattern in managing pain every day.

Pacing helps avoid the boom-and-bust cycle. It puts you, not your pain, in charge. If you can get into the routine of pacing, you can do more things with partners, family and friends and have a fuller life.

How to pace well

It’s important to realise that pacing skills take time to learn and you need to practise endless times over weeks to become confident using them. Pacing means finding the balance between what your mind wants you to do or you have to do and what is kinder for you and your body. It is planning and giving yourself regular rest breaks and time to restore energy: in other words, planning the route and your refuelling stops.

1. Decide which activities you need to pace

Think about your daily activities and how much effort they require. If any of these activities are difficult because of your pain, or if pain increases as you do them, then they probably need to be paced.

2. Find how much effort to put into each activity without causing more pain

It can be tricky to work out what effort level is right for you. So, for example, say walking to the local store is difficult. First, find how far you can walk before your pain starts or increases.

Think about:

• What is the speed at which I can do the activity? Slow, medium or fast pace?
• How far can I walk without more pain or tiredness?
• How often do I need to take rest breaks?

Let’s say you can usually walk 200 metres to a store at a medium pace and then the pain increases. To pace the activity, reduce 200 metres by half, and take a break at 100 metres. You can slow down your pace to manage energy too.

Take a break of, say, five minutes and then pace the walk, both the speed and effort, for the next 100 metres. Take a rest break again. Now you have walked into the store, 200 metres away, with little change in pain.

Use pacing for other activities – tasks around the garden or house, social events, work, etc. Discover how much you can do until the pain increases or interferes with the activity. Reduce the activity to half this amount, put in breaks and complete it. It is a truly useful habit. Others have shared that ‘Pain is life-changing and daunting, so always break activities down into chunks, tackle them one by one and even if you are taking baby steps, you will still move forward.’

Using regular breaks you can do more throughout the day, with less pain or tiredness, and you will steadily build up body stamina.

3. Be aware of how your body feels in the moment

You may find that if you are feeling tired or stiff or have more pain than usual, it helps to take a few extra breaks or give less effort to the activity. This isn’t always easy as your mind may be telling you to get the job done now or finish the activity today, despite your pain. Think how to achieve a balance between what you want to do and what you can do without increasing your pain.

Experiment with the balance between effort, activity and pain and/or tiredness to find the kindest level for you.

Tools and tips to help pace well

Pacing needs practice every day and works well with goal setting. People with pain find these tips help them:

• In a break time, have a chair or bench to sit on. Do some simple stretches. Listen to some pleasant music.
• Use a timer from your kitchen or on a mobile phone to tell you when it’s time to take a break.
• Add in a drink break to your activity plan. Use a timer to make the break long enough!
• Ring a friend or make a phone call as a break.

Ways to deal with difficulties with pacing

You will have found out already that your mind can get in the way! It’s common to fall into the ‘all-or-nothing thinking’ trap. You set off on a task and think, ‘I’ve started, so I’ll finish it now’. It is hard to accept that some things can be finished later. Or you may stop doing something you enjoy altogether as you can’t do it as you used to. This way of thinking is very common. It is a block to pacing well and pushes you into pain setbacks.

Pacing needs balanced thinking and these ideas may help:

• Notice unhelpful thoughts like ‘must’ or ‘should’ and replace with ‘could’. For example, instead of thinking ‘I must get it all done today’, try thinking ‘I could choose to pace this and do it in stages over two or more days’. Experiment and see what actually gets done without more pain.
• Let go of the idea that all the jobs get done today. It is not giving in, except to pain!
• Prioritise – tell yourself some things can be done later, tomorrow or next week.
• Tell the people around you that you are practising pacing. Ask for their support to help you pace well.
• Check the effort levels of the activity. This skill of matching effort and activity helps make certain the balance is right for the situation or plan. A low effort level means things may not get done, may take ages and frustration may move in with the lack of progress. But too much effort and you crash out with a setback.

So treat it like checking the temperature in an oven. Too little heat and the dish is undercooked; too much heat and the dish burns.

Balancing the body and mind together on activities helps do what you want to do. This will help you to control your pain and life with more success and less stress and to move on in your life journey.

Give pacing a go – start with a pacing plan and reward yourself for achieving a helpful habit for life.