Tips on pacing when you have chronic pain.
What is Pain?
Pain is often thought of as a direct proof of tissue damage. This can be true in the case
of acute pain, but becomes a different story in chronic pain. The body has sensors
that detect temperature, chemical, or mechanical changes, and sends a signal to the
brain. This signal is not a pain signal but a ‘danger’ signal and the brain will produce
pain based on how much danger it decides you’re in by drawing on the signals from
your body, and context including past experience, emotions, and beliefs.
This is why pain doesn’t always match the amount of tissue damage. A minor paper
cut can be surprisingly painful, while a serious injury sustained in a high-adrenaline
moment (a car accident, a football tackle) may not hurt until later. The brain is
constantly weighing up how threatening a situation is and produces pain to protect
you, not simply reporting damage.
Understanding this helps explain why chronic pain can persist long after tissue has
healed, and why factors like stress, sleep, mood, and beliefs about pain can all
influence how much pain you feel.
Acute vs Chronic Pain
How does acute pain differ from chronic pain?
Acute pain is short-lived. It might be brief, such as banging your elbow, or last a few
weeks, such as a badly sprained ankle. In general, acute pain lasts less than three
months. It’s also useful information, in the case of a sprained ankle, it helps guide
rehabilitation and non-weight-bearing periods.
Chronic pain persists longer than the normal tissue healing time, or has been present
for more than three months. With chronic pain, the pain signal is no longer helpful
and often has little correlation to the original injury. Using the sprained ankle
example, healing time depends on the grade of injury, let’s say 6–12 weeks. If pain
persists beyond that, the tissue has healed as much as it will, and the pain is no longer
being driven by tissue damage. This is an important mindset. Chronic pain is
multifaceted, shaped by many factors including emotions, beliefs, the circumstances
of the original injury, and the responses of people around you.
It’s important to remember that your pain is real, regardless of what’s
contributing to it, how long it has lasted, or the original cause of injury.
Why does movement matter in chronic pain?
Movement has many benefits for people living with chronic pain, including:
- reducing the effects of deconditioning
- calming nervous system sensitisation caused by chronic pain
- improving your baseline tolerance for activity
- desensitising pain-related anxiety
- increasing your ability to return to greater functional capacity
Top 6 Pointers on Activity Pacing in the Presence of Chronic Pain.
Pacing is essential when building activity back into your routine with chronic pain, it
helps minimise flare-ups while you continue to make progress.
- Think about what you know you can achieve, and start there.
◦ For example, if a 15-minute walk increases your pain, start with 10 minutes
and build from there.
◦ How you recover is important feedback on how much activity you can tolerate.
Initially, it helps to leave a rest day between structured activity days to assess
recovery. This guides you and your Exercise Physiologist on when to add
activity days or introduce something new. - Consistency is key — do it, and do it regularly.
◦ As with any skill, strength, or fitness goal, consistency drives good outcomes.
Tennis players don’t improve by playing once, they train regularly, including
through setbacks and frustration. The same applies to building your tolerance
to activity with chronic pain: the key is doing it, and doing it consistently. Your
Exercise Physiologist will help set your routine. - Set goals to work towards.
◦ Start with smaller, short-term goals that build towards a bigger, longer-term
one.
◦ Your goals should be relevant to you. If lifting 20kg is needed for tasks at home
or work, your Exercise Physiologist can target your program around that. If
you rarely or never need to lift 20kg, that isn’t a useful goal for you. - Don’t wrap yourself in cotton wool — and don’t let family or friends do it
for you.
◦ Having pain doesn’t mean you need to stop everything. Some tasks, like heavy
lifting or running, may need a break for a while, but as your tolerance
improves with proper pacing, you’ll reintroduce these over time.
◦ It’s hard for family to watch you in pain, so they often take over tasks to
prevent it worsening. This can help in the early, acute stage of an injury, yet
with chronic pain, it can reinforce feelings of disability and helplessness. Be
sensible about what you can still do, for example, wiping benches or prepping
vegetables rather than cooking a full meal. As your activity program
progresses, you’ll be able to take on more again. - Avoid the boom–bust cycle.
◦ “Boom–bust” describes what happens when someone has a good day, does the
whole house, the car, and a big grocery shop, only to trigger a major flare-up
that stalls all activity for the rest of the week (or longer).
◦ Spreading tasks across several days improves your overall productivity, rather
than trying to do it all at once. It may even leave you with something left in the
tank for something special.
◦ Try cleaning the house over 3–4 days rather than fitting it all into one.
◦ This can mean having to review your ingrained expectations and standards,
whilst learning to be flexible and compassionate to yourself; easier said than
done and a psychologist will assist in learning these skills. - You don’t need to go it alone.
◦ Your GP plays an essential role in helping you live well despite pain and build a
strong, trusting relationship with all your treatment providers.
◦ Exercise Physiologists (EPs) are a great addition to your health team. EPs use
movement as treatment, prescribing it based on your individual needs. Their
guidance can make the difference between steadily building your activity
tolerance and staying stuck.
◦ Understanding pain concepts is key to helping someone with chronic pain see a
life beyond pain. EPs are trained to support this understanding as you build
activity. Other practitioners, such as psychologists, can also be valuable. Make
sure everyone on your team has a solid understanding of pain science, so
you’re getting consistent, accurate information.
◦ There are good resources online to help you understand chronic pain but be
wary of misinformation or confusing advice. Talk to your treatment providers
for guidance, or give us a call at Body Dynamics. The Agency for Clinical
Innovation is a good place to start; search “Chronic Pain – Agency for Clinical
Innovation” in your browser.
Having a Flare Up Plan
Even with good pacing, flare-ups will happen from time to time, that’s normal, not a
sign you’ve failed. Having a simple plan in place makes them easier to ride out:
- Scale back, don’t stop. Drop back to a level of activity you know you can manage,
rather than resting completely; complete rest for extended periods can make a
flare-up harder to recover from. - Use your known strategies. Whatever has helped before, heat, gentle movement,
relaxation or breathing techniques, pacing your day; lean on these rather than
waiting it out passively. - Expect it, don’t panic. A flare-up doesn’t mean you’re back to square one or that
the damage has worsened, it’s your nervous system reacting to a build-up of stress
on the system. - Build back up gradually. Once things settle, return to your previous activity level
in small steps rather than jumping straight back to where you were. - Debrief with your Exercise Physiologist. Flare-ups are useful information, talk
through what happened so your program can be adjusted if needed.
Not sure where to start? Get in touch at admin@bodydynamics.com.au and we’ll point
you in the right direction.
