Chapter 19

Pacing: Balancing
Activity and Rest

Pace Yourself

A local establishment in my neighborhood has a sign in front that displays various inspirational phrases. They will have familiar sayings like, “An apple a day keeps the doctor away” or, “If you believe, you can accomplish great things.” But last week the featured message really got my attention. It said, “I don’t work until I’m tired—I work until the job is done.”

While this may be a helpful message for kids who are learning to develop a good work ethic, this is exactly the wrong message for patients with chronic pain. Our culture so values hard work and productivity that it is a sign of dishonor or weakness to do anything less than “get the job done now.” It’s part of our cultural DNA to always work longer and harder, no matter what ill effect it has on our physical, emotional, and spiritual health. This stoic mentality is hazardous for the chronic pain sufferer, whose muscles, nervous system, and connective tissue are already taxed beyond their limits.

Why Does Chronic Pain Cause
Problems with Pacing?

You have likely found that chronic pain has changed every aspect of your life. One of the most basic yet important ways this happens regards how you carry out your daily activities at home and work. Chronic pain often leads to profound changes in our approach to activity, which manifests in different ways.

Some people give up on activities to avoid pain. They’ll skip things like physical exercises, self-care, errands, or interacting with family and friends. Why do they choose to remain inactive? Perhaps the tendency toward depression, hopelessness, or exhaustion puts them in a passive mood. Maybe they have a sense of themselves as fragile and are just being cautious. It could be they have lost interest in activities because their pain has become so front-and-center that it dominates their daily attention. They feel there is no room or energy left for activity. Others withdraw because they feel ashamed or embarrassed to be seen in public when their health is less than vibrant. For these people, it is not acceptable to be seen as anything less than 100 percent capable at all times.

Others may choose inactivity because they have learned to disconnect from the sensations of their body until their body has to protest in the form of a major pain flare.

Others respond to their pain in the opposite direction. They defiantly push through while ignoring how they feel. They want to prove that their pain isn’t defeating them. Why does this happen? They fear the danger of a slippery slope if they slow down at all. Unless they keep pushing themselves, they believe they may end up becoming disabled or debilitated.

The fact is that having chronic pain requires you to pay attention to things that people without pain don’t have to. The goal is to find a moderate path to activity, which means pacing yourself. You must avoid the extremes of doing too much or doing too little. Learning to pace yourself is centrally important because it allows you to stay active. Pacing reduces pain flares, allowing you to do more of what is important to you. By regulating your rate of activity, you can feel more in control of your life.

Researchers have pointed out that pacing has two main benefits. First, it conserves energy for activities that are most important to you. Second, by starting a particular activity at a reduced rate, it allows you to gradually increase your time of doing the activity.

How does pacing work? The goal is to find the amount of activity that you can do without experiencing a pain flare afterwards. That limit applies to all activities—walking, biking, lawn mowing, light housework, etc. This is a little tricky at first, because sometimes there is a time delay between activity and flare. The flare may occur anywhere from two to twenty-four hours after the activity. It is best to start slow and give yourself a day of rest afterward to note the response. When you find the right amount of flare-less activity, stick with that amount, three to four times weekly. After a week or two at that rate, you can moderately increase the activity time. For example, if you are walking fifteen minutes daily, try increasing that amount to twenty minutes, and be sure to apply the twenty-four-hour test before staying at that higher level. This reduces the chance of a pain flare while you build your strength and endurance. Pacing enables you to gradually and safely increase your ability to do daily activities and reduce disability.

The Danger of Feeling Good

One of the most common causes of a pain flare is overdoing it on days when you feel less pain. It is human nature to want to do more than usual when you feel better. So, it is very important to stick to your schedule even though you are feeling unusually pain-free on a particular day. Avoid the temptation to increase activity levels too much too soon.

As you learn the art of pacing yourself, one of your greatest tools is practicing sensory awareness of your body. This stems from the common tendency of pain sufferers to disconnect from the sensations and emotions experienced in the body because, well, it hurts. You need to stay alert to this bad habit of somatic disconnection. I keep repeating the importance of connecting to sensations in the body because it is an essential empowerment skill for managing pain. My motto is, “You can’t change it if you can’t see it.” You need to pay attention to your body because it always provides you with clues in advance of a flare-up. For example, if you have low back pain, the clues could be a little sense of tightness in the low back, a subtle fatigue in the upper legs, or a slightly elevated sense of general agitation. If you ignore these sensations, then your body will turn up the volume on the pain to get your attention.

When you do notice the subtle tightening that precedes a flare episode, you can take steps to prevent the flare. Perhaps stop the activity you’re engaged in. Do a three-minute breathing technique. Take five minutes to gently practice some of your stretching exercises. And then congratulate yourself—you have taken an important step toward making the next pain flare less likely!