GOOD DAYS AND BAD DAYS

Liz MacLeod is a physiotherapist with a pain management programme. She explains why pacing your daily activities can prevent those bad pain days.

In my leaflet on Exercise, we looked at regular exercise practice and the value of this in building up fitness. When you have chronic pain, you lose fitness. This happens not just because you may have been unable to keep exercising but also because of the amount of time you find yourself resting and recovering from pain flare-up. Do you have a good understanding of your flare-ups? Do you know why you have good days and bad days with your pain? Flare-up is the topic of another leaflet but I thought this time we would look at the good days and bad days and see if we can work out a way of avoiding them.

GOOD DAYS AND BAD DAYS

What do you do on a good day? Do you use it to catch up on all the things you have been unable to manage on your bad day? Patients on the pain management programme describe this habit. They wash windows, do shopping, get out into the garden, all in an attempt to catch up. Sometimes they know they will pay for it next day but are driven on to do it anyhow by feelings of guilt, frustration or maybe just that it is enjoyable to be in the garden and worth paying for. Sometimes patients feel the pain is maybe on the mend and they carry on with fingers crossed! The end result of this increased activity on a good day is almost certainly increased pain. This in turn leads to enforced rest, probably an increase in painkillers, low mood and, as a consequence, less gets done. We call this cycle the overactivity-rest cycle.

SO WHAT IS THE ANSWER?

If you use a paced approach to activities, gradually pacing or building up the amount you do, you will reduce the number of bad days and may do away with them altogether. This sounds simple and it is in theory, but it needs some thought and, most of all, application.

FINDING YOUR BASELINE

Find a baseline for the activity that flares you up. The baseline is the amount of that activity you can do before you feel the pain increase. Take note of that time and use it to set levels for that activity, however you feel. This sounds easy! The hard bit is to stop that activity at baseline levels when you are having a good day and are enjoying what you are doing. It is so tempting to carry on, for example, walking outside on a nice, warm summer day, until the pain stops you. The result, of course, of ignoring your baseline is pain flare-up later that day or next day, and you’re back in the overactivity-rest cycle with the pain in control again. We have baselines for all our activities including less active activities such as sitting. Sitting beyond baselines can give flare-up too. You have probably experienced sitting watching an interesting programme on TV and becoming absorbed. You may also then have experienced pain when you moved at the end of the programme. This means you have sat too long, i.e. beyond your baseline.


If you learn to use your baselines effectively, you can perhaps manage to do the same amount of activities in your day, but spaced out over the day. Hoovering the house would be a good example. If your baseline was half a room, you could split the hoovering up into this size of chunks, and space them throughout the day, and still complete the task of hoovering the house without ending up in pain.

The rewarding part about sticking to baselines (apart from avoiding the overactivity-rest cycle) is that you can extend these baselines so that you are able to manage more of the activity as you practise. This is because your fitness levels are increasing all the time, rather than being lost while you rest and recover from the flare-ups. It is much more enjoyable to be "in control" rather than have the pain stop you all the time. You will find your confidence grows as you feel able to manage more activities and have more successful outcomes of your efforts.

WHEN LIFE GETS COMPLICATED

Some of the activities we do are complex. Golf, for example, has lots of "bits" to it. You have to walk, carry, bend, stand, swing the club, not to mention getting to the course, which may include a walk, bus or car journey! It may be that in order to play golf, you need to find the baseline for all the "bits" and work at these in order to pace up your levels.

Shopping is another complex activity which patients with chronic pain find difficult. Again breaking the activity down into its parts and setting baselines is helpful. You may need help from family and friends to begin with, so that you can stop at baseline level, but if you can pace each part of the activity up you will be able to do more and more yourself.

SUCCESS IS SWEET

If you use a paced approach to activities, you will reduce the number of bad days and may do away with them altogether. This sounds simple and it is in theory, but it needs some thought and, most of all, application.

Physio Footnotes © Liz MacLeod. All Rights Reserved.