Living a Healthy Life with Chronic Pain (17 page)

Hitting the right balance between activity and rest sounds like it should be easy, but it can be tricky. Balance is very individual. A balanced schedule for one person may be overdoing it or underdoing it for another. That’s why you have to spend some time trying to sort out what is right for you. Through trial and error, you can find out what activities you can do and how long you can do them without a significant increase in pain. For example, you may find you can work at a certain activity for half an hour if you take off 10 minutes after every 30 minutes. Maybe you need five minutes of rest for every 15 minutes of activity. Or maybe you need five minutes of rest after every five minutes of a particularly difficult activity for you. The goal is to find a reasonable comfort level while still being active. Set a timer to help you remember rest periods.

Your rest periods might be a time for you to get up and walk around, stretch, practice relaxation techniques, call a friend, listen to music, or read the paper. At the end of the day you may discover that you were active for a total of four or five hours without significantly increasing your pain. In contrast, if you had pushed yourself to work three hours straight without a break, you might have increased pain to the point where you had to stop. In this way, you can accomplish more if you build in breaks.

Planning rest breaks before pain forces you to stop an activity is a key technique of pacing. This technique is called working to schedule. This is in contrast to working to tolerance. When you work to tolerance, you push yourself to your limit. Pain begins to escalate, becoming significantly worse. This does not need to happen if you systematically plan bouts of your activity and rest periods. When you plan and stick to your schedule, you are in control, not your pain!

What activities do you do in the normal course of a day? The best way to find out is to keep a diary of your activities for a couple of days. See the sample Activity and Rest Diary on
page 108
of this chapter. This diary will help you to establish your baseline. Be sure to track at least one weekday and one weekend day. You can use the form at the end of this chapter, or simply list each hour on a piece of paper and jot down all your activities as you go about your day. Be sure to include your rest times. Note the amount of time you spend doing each activity or resting. Also note whether your pain staysthe same, increases, or decreases when doing the activity. This can be done with a pain intensity scale, with 0 representing no pain at all and 10 the worst pain imaginable. (See
Chapter 11
,
page 184
for more instructions.) Once you have your diary notes, you will get a sense of how you actually spend your time—the activities you do, how long you do them—and how activity affects your pain. Then, you will be able to see whether you are resting so much that you accomplish very little in your day, or whether you push yourself too much, spending too long at an activity before taking a rest.

Dr. David Corey, the clinical director of the Function and Pain Program at Mount Sinai Hospital in Toronto, has spent almost four decades working with people who have pain. He suggests a three-part program for self-managing and pacing. Why not give the following suggestions a try? (Dr. Corey’s book is available free on the Internet. See Suggested Further Reading at the end of this chapter.)

Each evening, prepare a schedule for the following day. Each night, decide what time you will get up the following morning and what your activities will be. Establish realistic goals. Ask yourself, “What do I really want to get done tomorrow?”

It is important not to overschedule your activities. For each one activity, think about how certain you are that you can accomplish that task even on a “bad” day. If you are not at least 70 percent sure you can do the activity, you may be taking on too much. In that case, cut back so you will be able to meet your activity schedule. Over time, you will be able to do more. This process follows the same principles as action planning, discussed in
Chapter 2
.

Chapter 2
also discusses problem solving and decision making, two other critical self-management skills for pacing. Think about how you can use those skills for pacing your activity and rest. Also, you might find it helpful to purchase an inexpensive daily planner at a business supply store or local drug store. It will list the hours of the day for each day of the week, with space for writing in activities and rest periods. This can make planning easier.

Schedule rest periods during the day, and take them at the specified times. You should be able to figure out from your diary how long you can do an activity before your pain increases. Learn to listen to your body. Often, our bodies let us know when pain is going to get worse. You might feel an extra tightness, muscle twinge, or spasm in an area of the body that hurts. A cue like this is almost like a yellow warning sign telling us that pain is on the way up—that it’s going to go from a 4 to a 6 out of 10 on the pain intensity scale. Learn to stop and take your rest break before you get this warning sign.

For example, you may be able to peel vegetables for supper for only 10 minutes before feeling that extra tightness in your neck and shoulders. With this in mind, schedule a rest period after every eight or nine minutes of meal preparation. On the other hand, you might be able to sit at a computer or drive a car for 30 minutes before feeling muscle twinges in your back. Schedule rest after 25 minutes of these activities. The idea is to plan your day so you get up and change activities before the pain forces you to stop what you are doing. Always plan ahead so you are preventing pain from getting significantly worse. That keeps you in control.

Taking a break is not a sign of weakness or failure; it is a wise move to allow you to gradually build up your stamina. As you improve, you may be able to reduce the number and duration of your rest periods. For those of you who go to work every day, it may not always be possible to schedule a rest. In that case, can you do a different task that allows you to change your body position for a few minutes? Can you get up and
stretch or take a short walk around the worksite? Sometimes a change is as good as a rest. Make use of your coffee and lunch breaks to relax.

When you plan your day, make sure all the time periods are filled with activities and rest breaks. Account for every hour of the day. This encourages you to be time-oriented (working to schedule) rather than pain-oriented (working to tolerance). You will tend to concentrate on your activity rather than on your discomfort, knowing that a rest break is coming up. Set a timer to signal your breaks so you don’t have to remember to look at your watch all the time. Take full advantage of rest breaks. You can spend the time productively in relaxation. Do gentle exercise, take a short walk, read, or call a friend. The one thing you should not do is worry!

When people first develop a schedule, they tend to overschedule activities. Resist this urge. Be realistic about what you can accomplish. Take it slow and build in rest periods throughout the day. Set your timer and take the breaks you built into your schedule. Scheduling is a skill that takes time to perfect. You probably won’t get it exactly right the first few times you do it. But be persistent and stick with it. It may seem tedious but once scheduling is a habit, it gets easier and faster and the results are worth it.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Caudill, Margaret A.
Managing Pain Before It Manages You
. New York: Guilford Press, 2009 (see especially
Chapter 4
).

Corey, David.
Pain: Learning to Live Without It
. Toronto: Macmillan Canada, 1993, 2004. Available as a free download in two parts at
www.healthrecoverygroup.com/pmp/pain_handbooks.htm
:

Turk, Dennis C., and Frits Winter.
The Pain Survival Guide: How to Reclaim Your Life
. Washington, D.C.: American Psychological Association, 2006 (see especially
Chapter 2
).

Complete the diary for a typical weekday and for a typical day on the weekend.

A
CTIVE PEOPLE ARE HEALTHIER AND HAPPIER
than people who are not active. This is true for people of all ages and conditions, including chronic pain. Not moving enough can cause or worsen pain, disability, and other illness. In order to better manage your chronic pain, you need to learn how to balance activity and rest.
Chapter 6
explained the importance of planning for appropriate rest periods throughout the day. Equally important is planning for regular activity and exercise.

Physical activity keeps you fit so you have the strength, stamina, and energy to do the things you want to do in life. Being more fit can improve your chronic pain over the long run. Scientific research conducted over the past 30 years has consistently shown that increasing physical activity helps chronic pain, improves functioning, and boosts overall health and well-being. In fact, exercise is most often the largest part of rehabilitation programs for people with chronic pain.

The bottom line:
keep moving!

You probably know that regular physical activity is important, but when you have chronic pain it can be difficult to know what you can do and how to do it. The good news is that there is plenty of information available to help you get started and be successful. For example, there are government guidelines that explain the importance of physical activity and offer programs to get going. These guidelines spell out what kinds of exercise or physical activities are best and how much you need. In this and the following two chapters, you will learn about these guidelines and about how to make wise exercise choices.

Of course, learning what to do is not enough. You also have to do it! It is up to you to make your life more enjoyable, more comfortable, and healthier through physical activity. As is the case in every chapter, the information about exercise in this book is not intended to take the place of medical or other health professional advice. If you already have a prescribed exercise plan that differs from the suggestions here, be sure to share this book with your health care provider or therapist before beginning this program.

Decades of research confirm that regular exercise is key to a healthier life. It can prevent and help in the management of heart disease and diabetes. It improves blood pressure, blood sugar, and blood fat levels. Exercise can help you to maintain a good weight, which takes stress off your weight-bearing joints. It is also part of keeping bones strong and treating osteoporosis. There is evidence that regular exercise can help prevent blood clots, which is one of the reasons it can be of particular benefit to people with heart and vascular diseases. Regular exercise improves levels of strength, energy, and self-confidence and lessens feelings of stress, anxiety, and depression. It can help you sleep better and feel more relaxed and happy.

In addition, regular exercise has consistently been shown to be the single most important thing you can do to manage chronic pain. It improves the ability to do normal activities; reduces pain, tenderness, and fatigue; and increases muscle strength in people with various types of widespread pain, including fibromyalgia. It also lessons pain and improves function in people with chronic back pain. Strengthening and stretching exercises improve chronic neck pain and some types of headache. Strong muscles help people with arthritis protect their joints by improving stability and absorbing shock. Regular exercise also helps nourish joints and keeps cartilage and bone healthy. Many people with leg pain from poor circulation or other causes can walk farther and more comfortably with a regular exercise program.

That is all good news. The better news is that it doesn’t take hours of painful, sweaty exercise to achieve health benefits. Studies have shown that even short periods of moderate physical
activity can improve health and fitness, lessen pain and improve everyday functioning, reduce disease risks, and boost mood. Being active also helps you feel more in control of your life and less at the mercy of your chronic pain.