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  • Writer's pictureJess Mcdonald

PAIN & PACING

Updated: Jul 7

How do we change your chronic pain patterns? Have you been in pain or discomfort for more than 3 months? Has your pain started to affect other parts of your life?


Pacing may be for you.


Remember you don't have to tackle this alone, no matter where it is; neck, back, and shoulder pain can be really isolating, we are here to help and work with you to get confident again in your body. At Move Sports Physio & Pilates in Belmont Geelong, you can book online, we offer after-work appointments, or if you would like to know a bit more about us check out our Facebook or Instagram.


So what the heck is pacing?


Pacing aims to utilize operant learning to positively influence pain behaviors and increase self-management (Nielson, Jensen, Karsdorp, & Vlaeyen, 2013). In normal language this means, it teaches your body to learn to cope with new load demands over time, allowing you to live with and manage your pain.


What are the goals of Pacing?

Pacing aims to reduce the activity of the pain system. Ie dial down your pain response. It works by using positive reinforcement or the absence of negative outcomes post-activity (pain after you do something fun) (Gatzounis, Schrooten, Crombez, & Vlaeyen, 2012).


This can result in:

  • interacting in a meaningful way with friends and fulfilling social roles within the community,

  • increasing feelings of success - woohoo

  • changes in your beliefs about pain

  • improving self-esteem

  • improving tissue capacity ie get stronger and fitter


(Macedo, Smeets, Maher, Latimer, & McAuley, 2010)


This sounds great - How do I do it?


Identify a meaningful activity goal that can be repeated, graded and is important to you (Gill & Brown, 2009). Effective pacing shifts the focus from pain to goal-directed or time-directed activity (Nielson et al., 2013). Ie set your focus on the activity, not on the pain.


What does that look like in real life?


How to apply pacing , a patient example:

Collaborative with you physio/health care team to set a goal or activity that you would like to work towards. At Move Sports Physio in Geelong, we love to work with you and your goals, we know this can be tricky to go it alone. Our job is to collaborate wi you and get you confident in your body again and improve your strength, fitness, and relationship with your body.


Case Study - Meet Paula, she has had persistent neck pain for 3yrs it effects her ability to work, socialise and be a mum to her growing family of boys.


Goal = Cooking in the football canteen.

Activity = cooking with the help of Paula’s family.


Setting a low baseline.

Paula can complete standing at the bench chopping/ string for 10min.

During a discussion with the physiotherapist, this activity pacing doesn’t include lifting, something that increases Paula's fear of pain.


Identify Boom / Bust Behaviour (we will cover this in detail in another post)


Paula’s past behavior included avoidance of the football canteen and absence from social interactions at the club. Paula previously pushed herself to cook for 3 hours , and experienced pain for a week which resulted in fear avoidance, inactivity, and feelings of anger. Paula used to do Graph A, we are aiming for B & C.



Graph


Paula applies pacing by completing the same activity on days Paula experiences pain and those she does not.


ie Cooking with family ten minutes, five days per week, regardless of Paula's pain levels.


Paula slowly adds more time, or adds more complex tasks, increasing her tolerance to activity without pain flare-ups. With the help of her physiotherapist, strict time limits are set, regardless of the task, or pain levels. So even when Paula feels good she stays true to the time limit.

Sometimes this is the hardest bit.


As Paula transitions to the canteen, she maintains strict activity time limits and paces, until she is able to complete the whole activity without significant changes to her pain response.



Now if this sounds like something you are interested in, but now have more questions than answers. Please get in touch - we are passionate about pain and want to help you move again.



Jess a Physiotherapist at Move Sports Physiotherapy Geelong

REFERENCES


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Bennett, M. P., Meulders, A., Baeyens, F., & Vlaeyen, J. W. S. (2015). Words putting pain in motion: the generalization of pain-related fear within an artificial stimulus category. Frontiers in psychology, 6, 520-520. doi:10.3389/fpsyg.2015.00520


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Karjalainen, K., Malmivaara, A., van Tulder, M., Roine, R., Jauhiainen, M., Hurri, H., & Koes, B. (2001). Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine, 26(2), 174-181.


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