Ep. 21 Pacing: Flare Prevention & Energy Management

In this podcast episode, Dan and Juz explore the concept of pacing and give it a bit of a re-brand, going through their structure and personal examples to learn how to break down managing your timing, tasks and tolerance more effectively so you can reclaim activities and passions pain may have limited. Effective pacing includes careful planning, task batching, and managing context variables to adjust to fluctuating physical and emotional demands. Key strategies involve scheduling pressure-release activities, monitoring stress, and using graded exposure techniques to build resilience through movement. The episode emphasizes the importance of built in flexibility, encouraging listeners to shift tasks as needed and recognize that flare-ups are a natural part of the process, learning to adapt routines and lean on support networks to manage setbacks and regain your baseline quicker.

Episode overview:

So what's the big deal about pacing and what did we get into conversation about on the episode?

Understanding Pacing

Pacing is an active self-management approach where patients learn to balance activity and rest to optimize their energy expenditure (London Pain Clinic, n.d.). Frankly, it needs a rebrand though because it is not exactly inspiring to most folks. However, it's a non negotiable when it comes to managing complex pain or central sensitization in particular.

The main goals of pacing are:

• Spread activities evenly throughout the day and week

• Avoid pain flare-ups

• Gradually increase overall activity levels

• Take regular short breaks before pain becomes severe

• Alternate between different tasks and activities

Pacing helps break the cycle of overdoing activities on good days and doing very little on bad days, which can lead to a downward spiral of decreased function over time (Agency for Clinical Innovation [ACI], n.d.).

The Importance of Balance

Two key concepts in pacing are avoiding both underactivity and overactivity:

1. Underactivity: Doing too little can provide short-term pain relief but ultimately worsens pain by decreasing muscle strength and stamina.

2. Overactivity: Constantly pushing beyond limits despite pain and fatigue leads to exhaustion and ongoing pain flare-ups that demoralize and create hopelessness.

The goal is to find a sustainable middle ground between these extremes, and progress how much you can do over time. THERIN lies the true value of pacing. It is key to taking back what's yours, and what pain has stolen from you.

Planning Your Pacing Strategy

We outline a structured approach to implementing pacing that helps you see how to look at your needs/wants, schedule and available capacity to understand how pacing applies to you and your life:

1. Goal Setting: Establish clear, achievable goals for activities you want to reintroduce or improve.

2. Timing: Plan your day and week, considering when you have more or less energy and other variables like how easy a task is at a certain time vs another i.e. working out etc.

3. Task Management:

   • List essential daily tasks for yourself first, then others, prioritize self-care

   • Map out the things you need to do before the want to do's

   • Identify additional work or recreational activities

   • Estimate time requirements for each task

4. Energy Management:

   • Recognize that time management is really about energy management

   • Use strategies like task batching and minimizing task switching

   • Group similar cognitive or physical demands together

   • Plan for recovery time and transitions between activities

5. Flexibility: Build in options to shift tasks when unexpected demands arise

We use Juz's schedule and how she puts it together to avoid the boom and bust cycle, as well as adding a super intense activity like chorus in as a real life example on how to balance and integrate new toll.

Executing Your Pacing Plan

1. Stick to your plan, not your perceived limits on a given day

2. Be as committed to rest periods as you are to activities

3. Measure your progress, set new goals, and gradually increase capacity

Juz recommends several simple techniques for incorporating regular breaks physically or cognitively:

• Set timers or alarms

• Use the Pomodoro Technique (25 minutes of work followed by a 5-minute break)

• Follow the 52/17 rule (52 minutes of work, 17-minute break)

• Take microbreaks (30 seconds to a few minutes every 20 minutes)

• Use movement during breaks (e.g., stability exercises)

• Change your work environment regularly

Monitoring and Awareness

1. Build flexibility into your schedule to accommodate daily fluctuations in pain and energy levels

2. Use downregulating and desensitizing techniques during transitions between activities

3. Respect your current limitations while working to expand them gradually

4. Be mindful of the five stages of a pain flare-up:

   • Trigger/stressor

   • Loss of routine

   • Worsening pain

   • "The hole" (significant functional decline)

   • Digging yourself out

5. Adjust your daily routine as needed, but maintain consistency in your overall approach

Pacing Techniques from Research

Several evidence-based pacing techniques have been identified in the literature:

1. Activity Pacing: Breaking tasks into smaller portions and alternating activity with rest (Antcliff et al., 2018).

2. Energy Envelope Theory: Matching activity levels to available energy (Jason et al., 2013).

3. Graded Activity: Gradually increasing activity levels based on predetermined quotas rather than symptom fluctuations (Nielson et al., 2013).

4. Time-Contingent Pacing: Scheduling activities and rest breaks based on time rather than symptoms (Andrews et al., 2012).

5. Adaptive Pacing Therapy: Planning activities to minimize fatigue and symptoms, emphasizing energy conservation (White et al., 2011).

6. Quota-Contingent Pacing: Setting activity goals or quotas and gradually increasing them over time (Nijs et al., 2020).

7. Mindfulness-Based Pacing: Incorporating mindfulness principles to increase body awareness and make conscious choices about activity engagement (Carlson, 2012).

Conclusion

Pacing is a powerful tool for managing chronic pain and regaining control over daily activities. It does not have to be a depressing, death sentence to living your life on your terms. In fact, it is a critical tool to help you get there. 

By implementing a structured pacing plan that progresses over time as you gain capacity, patients can gradually increase their activity while minimizing pain flare-ups. The key is to find a balance between rest and activity, consistently apply pacing principles, and adjust strategies as needed based on individual circumstances and progress.

Continuing Education