A few years back, I had the opportunity to participate in an open group for those suffering from chronic pain. The approach was holistic in nature: looking at how one can effectively restart one’s life with pain. There was one important word I learned through the whole gambit, and that’s called pacing. It’s helpful towards my own dealings with both chronic illness, and chronic pain.
First, you need to figure out how you approach both pain and illness. There’s two camps, and I’ll start with the one I fall under: boom-bust. I’ve been doing my physio exercises, my titration seems to be stable, and I choose to take advantage of any moment of feeling ‘okay’. I’ll go out and do something telling myself I’m challenging my phobias, and think I can tackle more than one with no support.
One day, I hit the wall. The whole day is spent in bed, I possibly flare-up something, and it takes more time to recover than the last. I can’t do as much as before, and recovery time seems slower. Mentally, I’m demoralize and feel loss of hope. Below is a graph of a typical boom-buster.
Then there’s the second group who’s afraid of pain all together. They believe all activity leads to pain, so they choose to protect themselves by doing as little as possible. Sometimes this leads to doing nothing at all. On the physical side, too much inactivity is bad for the body, and ironically causes more pain. On top of this, it increases risk of other conditions that will cause more physical pain (obesity, blood pressure issues, heart problems, diabetes etc).
Mentally, it’s decided that any activity is too painful to bare, too much anxiety, and it’s safer to stay away from ‘that’. Not enough exposure causes strengthened mental strife, and possibly creates new problems such as depression. Below is a diagram of the cycle someone who’s afraid of pain (more physical than mental, but I believe one can see a correlation) falls. When I think about it, some of my trauma is still in this cycle.
This is where pacing can help anyone out there in a recovery process. Simply put, it’s finding the balance of both worlds: the level of sustaining an activity to gain something without reaching the point where you’re causing more pain. In time, you find self-resilience increase, confidence lifted, and the sense of being stronger (both mentally and physically).
I’ve found the hardest part of pacing is determining one’s baseline. To be able to do this, one has to be self-aware. How does my body feel after I eat? How does my mind feel after I went out? How do I feel today compared to yesterday? It’s a constant check-in of the self. Compared to what’s explained in both this group and many online chronic models, I do things backwards. I don’t find it helpful to figure out how long I can stand and figure out an average. Instead, I’ve learned to listen to my body’s cues. If after I’ve had breakfast and I start to do my physio regime, if I can only do 5 reps instead of my 10, I stop at 5. Instead of moving from activity to activity (movement), I do a physical activity, then move on to a mental activity (therapy homework).
Sometimes I can’t figure out what’s wrong: I’ve taken care of all my basic needs, and there’s no apparent reason for me to be ‘feeling off’. I take a nap. 40-50 minutes with an alarm to be sure not to disrupt my sleep schedule. My mind may or may not have lessened it’s ruminative behavior. That’s when I have to make a choice on what I should do, and yeah, I’ll always do something. Setting goals, even small, can help you get through these ruts. Planning is another activity in itself: I don’t have to do the list today, but now I have things I can focus on throughout the week.
I’ve had setbacks, so prepare to have them when learning this process. You’re not a failure if you boom-busted or fell back into the inactive cycle. Remember to start over as soon as you can despite what your brain tells you.
The saying pace yourself will take on a whole new meaning.