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Deconditioning
Prolonged or persistent pain can result in physical deconditioning, anxiety and low mood due to a reduction in the individual’s ability and desire to be active1, 2. [See Figure 2]. Conversely, overactivity can cause more pain, which could start the patient on the downward spiral of deconditioning1, 2.
Adapted from Scott E et al. Positive Management of persistent pain. SPHERE: a national mental health project. Educational Health Solutions, Vic, 20061.
The use of any pain relieving intervention must be considered in the light of the risk of harm by reinforcing passivity and attention to pain rather than restoration of function despite pain2. For example, pharmacological agents may be used to modify aspects of the pain experience, and depending on the case, exercises and graded activity are used to rectify the pattern of activity avoidance and ensuing loss of fitness and strength. In turn, by starting to achieve a few goals, this leads to a sense greater sense of optimism and further efforts to rehabilitate by the patient1,2.
Pacing
Pacing involves a gradual introduction of graded activity to rectify the pattern of activity avoidance and ensuing loss of fitness/strength. In turn, by starting to achieve a few goals, there is often an improvement in the patient’s mood, a greater sense of optimism and further effort to rehabilitate1, 2. Counsel patients to expect more pain initially, just like at the start of a sporting season when a player has been out of action for a while. Further tips on how to pace are given below1, 2:
Tips on how to pace
- Take frequent short breaks
- Break up the task into smaller pieces
- Gradually increase the amount of activity
- Do more on good days, less on bad days – don’t overdo things
- Start on activities that are easier
- Ask for help with specific tasks now and then
- Keep to targets and plans as much as possible
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