Pacing Yourself Can Help With Chronic Pain and Fatigue

For people with chronic pain and fatigue, completing tasks can be difficult when experiencing a flare-up. Some may push themselves too hard or avoid tasks altogether. Pacing yourself—or taking a break before you need to—can be one way to limit these painful flares.

A small study published in early May found that among 12 patients who attended a rehabilitation center for issues related to chronic pain and fatigue many experienced the benefits of pacing after two sessions with a clinician while implementing pacing into their daily lives. The study was published in Musculoskeletal Care journal.

Patients in this study experienced symptoms of the following conditions for at least three months:

• Chronic low back pain
• Chronic widespread pain
• Fibromyalgia or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

The pacing framework included:

• Recognizing current unhelpful behaviors
• Finding baselines
• Practicing self-compassion
• Being flexible
• Gradually progressing activities

"The finding of the study are as expected and realistic," Medhat Mikhael, MD, pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center, tells Verywell. "In our clinical experience, it works for the majority of the patients, but there is some that it doesn't work for them, or they have a hard time complying with the schedule or with the consistency of the activity."

How Pacing Yourself Can Help Manage Energy

This research highlights the importance of embracing flexibility instead of rigidity for people with chronic pain and chronic fatigue when considering what they need to get done.

In the study, patients reported that key components of pacing themselves included:

• Breaking down tasks
• Saying ‘no’
• Being kind to themselves
• Using rest breaks
• Doing something each day
• Developing a structure
• Gradually building up activities

Mikhael says that patients with chronic illnesses like fibromyalgia, which is characterized by both chronic pain and chronic fatigue, may experience "boom and bust" if they do too much in one day, even if they feel okay at the moment. For example, someone with fibromyalgia may "want to clean the house, do the gardening, move some of this stuff here and there because she woke up with some energy and without as much pain," Mikhael says. "She then pays for that the rest of the week."

While it may seem that it takes longer to complete certain activities or tasks while embracing pacing, this may not actually be the case. For example, it may take less effort to plan to mow a lawn over three days compared to pushing yourself to do it in one day and dealing with worsened chronic pain and chronic fatigue in the week that follows.

"The biggest time saving is you spend far less time recovering from massive flare-ups,"
Shaliza Shorey, PsyD, a clinical neuropsychologist and co-president of the American Association of Pain Psychology, tells Verywell. "If your mood and physical and emotional health stay more stable, that's where the energy gains come from."

Pacing, while helpful, does not get rid of chronic pain, but it can help people better manage it. A 2019 systematic review published in the American Journal of Occupational Therapy found that pacing can help lessen joint stiffness and the interference of fatigue in someone's life. The review, however, did not find that pacing reduced the severity of chronic pain or helped change psychological traits associated with chronic pain.

Why Pacing Yourself Can Be Difficult

Some people with chronic illness may struggle with pacing because they may feel like they failed for doing less than what seems "normal." Other people may avoid doing activities altogether because they associate it with chronic pain or fatigue.

"What I say to [patients] initially is 'you know it's always hard for us to accept things that feel like they're being imposed on us things we didn't have a choice in getting diagnosed with a chronic condition, especially as a young person,'" Shorey says. "But the fact of the matter is, at some point or another, we're all going to have to learn to pace."

It may also take a while for some patients to realize that they need to work with their current chronic pain and chronic fatigue levels. Shamin Ladhani, PsyD, a pain psychologist based in Wisconsin, tells Verywell that some patients may bounce from doctor to doctor looking for a cure.

"We have to kind of find out where they are in that status of motivation to change before we can kind of say can 'we are in an acceptance place,'" Ladhani says. Pacing does not replace medication but it can help people manage their symptoms in conjunction with medication.

Some Strategies to Help You Pace Yourself

Whether working with a pain management team or independently, coming up with a pacing method that works for you is crucial.

Reminders

People with chronic pain and chronic fatigue do not have to adjust to a pacing style alone. Friends and family can both help hold a chronically ill person accountable and give them reminders.

"It can be a person in their life a friend or spouse who says, 'Hey, by the way, I was supposed to remind you to take a break 20 minutes later, you should probably get up and stretch out in between that activity or do pain reliever activity now if you've been doing a pain stressor,'" Shorey says.

Shorey also recommends that people with chronic illness and chronic fatigue leave stickers around their homes with reminders about their pacing goals.

Be Mindful of Your Energy

Ladhani says it is important that people with chronic pain and fatigue be mindful of their energy levels. If they feel their symptoms rising, they can tell themselves, "I need to do something that's kind to myself to give back so that I feel that I'm ready to do the rest of my day."

This could be reading a book or engaging with a self-care activity. "I also try to teach them to be insightful as to what are their energy drainers. What are the things that suck energy from them and to start to be aware of that," Ladhani says.

She also recommends, if possible, that people with chronic pain and chronic fatigue outsource some of their energy drainers, like cleaning, so they have the energy to do tasks—work-related or for fun—that they want to do.

Exercise

Pacing can also be helpful when re-engaging with or increasing physical activity. A 2017 systematic review published in the Cochrane Database of Systematic Reviews found that physical activity and exercise can help people better cope with chronic pain, and improve physical function and quality of life.

When getting back into exercise and other physical activity, people with chronic pain and chronic fatigue should not push themselves too hard right away. "We usually recommend like a 10% increase," Mikhael says. "So if you swim half a lap, or you swim some distance, you can make it back. And then you stop, but consistently started doing what you have increased."