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Family Health Magazine - SPECIAL CHRONIC PAIN SECTION

The Tortoise and the Hare
Pacing with chronic pain

Perhaps you have heard the fable about the tortoise and the hare. The two decide to race. The hare sprints away from the start line, easily pulling away from the tortoise, but runs out of steam and must rest. Meanwhile, the tortoise keeps up a steady pace and beats the hare. The moral – slow and steady wins the race.

What does this have to do with chronic pain? Many people who have chronic pain act like the hare. On days when they feel a little better, or have more energy, they burst out of the gate and try to get as much done as possible. They push through, going beyond their pain limits to check more things off the to-do list.

The problem is that the sprint cannot be sustained. Intense periods of activity are followed by an inevitable crash. The pain increases and energy drops. One day of intense effort can result in two or three days of significantly reduced activity because of pain.

Continuing this 'push through, boom and bust' approach can reduce abilities over time. Instead of building activity gradually and having pain levels subside, people find their symptoms increase. The overall level of function starts to go down instead of up. Eventually, it takes less and less activity to trigger a painful flare-up.

Others living with chronic pain take the 'wait until' approach. They choose to avoid activity until they feel better, when symptoms fade or they have more energy. It is a common way to put off tasks that they dislike or that make pain worse.

Again, there are problems with this approach. Relief from pain or increased energy may never come. Pain symptoms may stay the same. Avoiding activity for a long time can make overall functioning drop. Strength and endurance are lost. Tight muscles and poor posture may even start to cause additional soreness. Remember, the tortoise won the race by staying slow and steady, not by sitting down and doing nothing.

Most people combine the two approaches. They push through with activities they consider important or that they feel absolutely must get done. They delay activities that are unpleasant or will increase pain. Doing too much or too little lowers function over time. The solution is pacing.

Pace yourself

Pacing allows you to organize and carry out important tasks within your limits of pain and energy. You can use it for home, work, and leisure activities. Pacing involves creating a careful balance of rest with activity, and heavier tasks with lighter ones. It involves conserving your energy.

For many years, people with chronic diseases have used energy conservation. The same method helps those with chronic pain. If you have limited energy, you may tire easily or experience more pain. By planning carefully and using certain strategies, you can make the best use of your energy. The idea is to work smarter, not harder!

Try the following strategies:

• Eliminate unnecessary steps to a job. For instance, pre-soak dishes so you do not need to scrub them. Take clothes out of the dryer right away so that they do not need ironing.
• Sit to work when possible. Sitting uses less energy than standing and allows you to work for longer periods.
• Use the right tools for the job. Use long-handled tools if bending is hard. Extend your reach with a reacher. Use electric instead of manual tools when possible. Sharpen blades properly so your muscles do not have to work harder than necessary.
• Arrange work areas so tools are within easy reach.
• Work close to your body to use less energy.
• Store supplies and equipment close to where you are working to eliminate unnecessary walking. Some people keep two sets of tools in different locations.
• Use countertops and other surfaces to support work tools.
• Slide objects instead of lifting them.
• Move using smooth, symmetrical motions. Use your larger, more powerful joints.

Practical steps for pacing yourself

Step One: Decide which activities are most important to you.

List all the things you need, want, and have to do. Next, mark them from most to least important. Write #1 beside the most important, #2 beside the next, and so on until you are through the list. Also, mark activities you must do daily (D), weekly (W), and occasionally (O). Cross unnecessary activities off the list.
Many activities can be broken down and spread over several days. Others do not work this way and are simply too hard. Figure out which activities are difficult and decide if you want to delegate or hire them out.

Step Two: Think about how you can work smarter, not harder

Decide which jobs can be done as you sit. Figure out whether you can eliminate parts of the work or spread it out over a few days. Find the best tools and the best layout for each task. Come up with creative, fun, and efficient ways to spend your rest breaks.

Step Three:
Plan your week.

Get a week-at-a-glance calendar. Each Friday, plan the next week. Slot activity and rest times for each day and throughout the week. Keep the best times of the day and week in mind. Be sure to have a back-up plan for bad days or if you have to change your schedule.

Setting baseline and tolerance levels

Another part of the pacing strategy involves establishing a baseline and tolerance level for each of your activities. This can help you increase your overall tolerance for a specific activity, once your daily and weekly pacing schedules are established. Again, there are a few steps to finding your baseline and tolerance levels for an activity.

• Over time, become comfortable with rating your pain on a numbered pain scale (where 0 is no pain, and 10 is the worst pain imaginable).
• Next, choose an activity.
• Now, establish a baseline, which is half your tolerance level. There are two ways to determine your tolerance level :
• start the activity and keep track of how long (in minutes), how far (in blocks or miles), or how intensively (using pounds or repetitions) you can do it.
• stop once your pain increases one to two points on the number scale, or stop when you feel that by continuing, your increasing symptoms would affect your ability to function later.
• Divide the activity time, distance or intensity in half. This is your baseline.
• Do your activity at the baseline for two weeks. On bad days, stick with your pacing plan. On good days, do no more than your baseline.
• After two weeks, increase your activity by 10 per cent. For instance, if your baseline for typing is 10 minutes, add one more minute to build to eleven. Continue to slowly build every week.

Remember, these are just general guidelines. Establishing a baseline and tolerance may not work for all activities and all people. Talk to your health care provider about any questions or concerns.

If you have chronic pain, pacing can be a very effective way to help increase your level of function. Keep the lesson of the tortoise and the hare in mind, and avoid doing too little or too much.

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While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [GO_FHc11]