Session 10: Pacing
I. Review of Homework – Questions for the Doc.
II. Activity-Pain Cycle
III. Definition of Pacing
IV. Steps to Pacing
V. Summary
VI. Homework – Practicing Pacing
VII. Relaxation Technique - Visualization
Session 10: Pacing
I. Review of Homework – Questions for the Pain Doc.
II. Activity-Pain Cycle
Has this ever happened to you?

You feel okay, so you jump up to get as much done as you can, then your pain goes up, you aren’t able to do anything, so you rest, at least until you feel good again.

When people in pain attempt to perform activities, they often do not stop until their pain forces then to stop.
Activity-Pain Cycle:
Prolonged Rest
Extreme Pain
Activity-Pain Cycling is very common. Some patients are very active during the day and spend almost all of their time in the evening reclining. Other patients may have 2 or 3 days of over activity, followed by 4 or 5 days of rest.

1. What are some reasons you might get stuck in the Activity-Pain Cycle?

Example Answers:
General Reasons
External Factors
Internal Factors
Overdoing Activity
Financial Problems
Resting Excessively
Need to Care for Your Children
Anger, Guilt
2. What does this teach you? What do you learn?

Example answers:
1. All activity causes pain.
2. Rest relieves pain.
3. Pain is a signal to rest.
4. Avoid activity.
5. Pain is in control of my life.
1. Increase in pain over time.
2. Little gets done.
3. Avoid activity (depression, less fun).
4. If you always push to the point of severe pain, you guarantee that activity will always be followed by pain.
5. Sets up apprehension, avoidance, and fear of activity.
6. You no longer control your life.

For Example:
1. Gradual increase in activity.
2. Based on pre-set goals, not on pain.
3. Reach a level of maintenance, then stop.
III. Definition of Pacing:
Pacing – is listening to your body and engaging in activities and rest in a manner which maximizes daily functioning and your pain.

Activity-Rest Cycle:
Moderate Activity
Limited Rest
Activity-Rest Cycle – is a method to help patients control pain by learning to pace and then gradually increase their activity level. Activity levels are contingent on time, not pain. Patients set goals to engage in moderate activity followed by limited rest.

Benefits and Limitations of the Activity-Rest Cycle:

1. You get more done.
2. Pain tends to decrease over time.
3. Your strength and flexibility increase.
4. You control your life, not your pain.
5. There may be setbacks, but appears to be most effective.

1. Requires record keeping.
2. Tends to structure the day.
3. Can interrupt ongoing activities

Most patients agree the benefits of pacing far out weigh the limitations.

IV. Steps to Pacing:
1. Things to consider before you begin using pacing.

· You need to decide what tasks are important. (Are there things you can get assistance with? Can you ask/hire others to do some or all of the tasks? Remember it may not be necessary to do a task in the same manner that you have always done it.)
· What has to be done today and what can be put off?
· Where does the task have to be done? Some tasks can be relocated to make it easier.
· When is the best time of day for you? What things have times set by others (i.e. medical appointments, movies, parties, etc.)?

2. Set Baselines.

· A record of current activity-rest patterns.

Look at your current activity-rest patterns.
What patterns do you see?

3. Using the “Quota System.”

Explanation of the “Quota System”
· Average the time you spend engaging in activities and set a quota for activity.

Time I will spend engaging in activities _____ minutes.
· Average the time you spend resting and set a quota for resting.

Time I will spend resting _____ minutes.

4. Setting Subsequent Quotes.
· Gradually increase the time or amount of activity while decreasing the amount rest.

5. Keep records and graphs.
· So you can chart your progress.

6. Schedule activity in advance.

7. Reward yourself for improvement. Ask family to reward you.

Other Points to Remember:
· Organize your tasks so that difficult tasks are not done on one day.
· Organize your day so that activities are spread out through the morning, afternoon, and evening.
· Remember your down times! Plan rest breaks through out the day. Stop before exhaustion!
· Alternate heavy jobs with light jobs.
· Alternate sitting/standing and lying activities.
· Work at comfortable pace.
· Keep your schedule flexible to allow for the unexpected.
· Don’t forget to add fun into your day.
V. Summary:
1. Pacing Problem: Pattern of doing too much when you don’t hurt, followed by doing too little because you hurt.
2. Solution: Build up activity gradually.
3. Use steps in this to do it.
       · Baselines
       · Quotes
       · Records
4. Do not let pain be your guide. Use your level of activity as your guide.
IV. Homework – Practicing Pacing
V. Relaxation Technique – Visualization
Creating Your Special Place

In creating your special place you will be making a retreat for relaxation and guidance. This place may be indoors or out.
· Allow a private entry into your place.
· Make it peaceful, comfortable, and safe.
· Fill your place with sensuous detail.
· Allow room for an inner guide or other person to comfortably be with you.
To go to your safe place find a comfortable position in your chair or on the floor. Pause. Close your eyes…Walk slowly to the quiet place in your mind…Your place can be inside or outside…It needs to be peaceful and safe…Picture yourself unloading your anxieties, your worries…Notice the view in the distance…What do you smell? … What do you hear? … Notice what is before you…Reach out and touch it…How does it feel? … Smell it…Hear it…Make the temperature comfortable…Be safe here…Look around for a special spot, a private spot…Find the path to this place…Feel the ground with your feet…Look above you…What do you see?…Hear?…Smell?…Walk down this path until you can enter your own quiet, comfortable, safe place.

You have arrived at your special place… What is under your feet? … How does it feel? … Take several steps… What do you see above you? …What do you hear? Do you hear something else? Reach and touch something… What is its texture? Are there pens, paper, paints nearby, or is there sand to draw in, clay to work? Go to them, handle them, smell them. These are your special tools, or tools for your inner guide to reveal ideas or feelings to you…Look as far as you can see… What do you see? What do you hear? What aromas do you notice?

Sit or lie in your special place…Notice its smells, sounds, sights…This is your place and nothing can harm you here…If danger is here, expel it…Spend three to five minutes realizing you are relaxed, safe, and comfortable.

Memorize this place’s smells, tastes, sights, sounds … You can come back and relax whenever you want… Leave by the same path or entrance…Notice the ground, touch things near you…Look far away and appreciate the view…Remind yourself this special place you created can be entered whenever you wish. Say an affirmation such as, “I can relax here” or, “This is my special place. I can come here whenever I wish.”

Davis, M., Robbins Eshelman, E., & McKay, M. (2000). The Relaxation and Stress Reduction Workbook 5th Edition. Oakland, CA: New Harbinger Publications, Inc.
Death of a Painkiller?
2009-12-22 15:37:24

When an advisory panel to the Food and Drug Administration (FDA) recommended a ban on acetaminophen-containing pain relievers in June 2009, the response was quick and angry. We were deluged with consumer calls, says FDA spokeswoman Karen Riley. Why the outcry? The panel had suggested that the FDA remove acetaminophen from all prescription drugs, including Percocet and Vicodin, two of the most popular painkillers in the world. The panel also advised lowering the amount of acetaminophen in over-the-counter medications like Tylenol from 500 milligrams to 325, which would cap the maximum daily dose at 2,600 milligrams. The reason: Every year, about 400 Americans die and 42,000 more visit the ER because of acetaminophen overdoses, which can lead to liver damage.

The Sound of Music Eases Pain
2009-12-22 14:55:35
Researchers at Glasgow Caledonian University in Scotland found that people who were listening to their favorite music felt less pain and could stand pain for a longer period.
Running Barefoot Eases Pain
2009-12-22 14:54:49
Scientists have found that those who run barefoot, or in minimal footwear, have a very different stride from their shoe-wearing peers. The sneaker-less tend to avoid "heel-striking," and instead land on the ball of the foot or the middle of the foot. By landing on the middle or front of the foot, barefoot runners have almost no impact collision, much less than most shod runners generate when they heel-strike.