Sometimes the most frustrating thing about pain is not the physical experience of pain itself, it’s the things it stops you doing – the things you love, but also the everyday things you have to do. This frustration can, unfortunately, lead to the development of a cycle which we call boom-and-bust.
How does the boom-and-bust cycle develop?
Even those experiencing chronic pain have comparatively good and bad days. On a good day, when the pain is not so intense, it’s natural that we want to take advantage of the decreased pain and catch up on some of the tasks we’ve missed. Because there’s so much to do, these good days often see a significant increase in our activity levels.
Sometimes, the bad days go on for too long without a good day, and we decide to just push through and do what we need to anyway, regardless of the pain. Just like the good days, we experience a significant increase in activity in short space of time – this period of activity is known as a “Boom”. Unfortunately, when there’s too much activity in a short space of time, we quickly feel the consequences. When you wake up the next morning, the pain has intensified. You’re likely exhausted, sleep deprived, and frustrated that even the good days seem as though they’re always followed by the bad. Because the pain is so intense, you have to rest – and rest for a while. This period of forced rest after a pain flare can last for several days, and is known as a “Bust”.
Unfortunately, during the bust, your activity level is lower than usual. As a result, your muscles atrophy, and your joints stiffen, and even after you’ve recovered, the pain is a little worse. That means that we reach our breaking point sooner in the next boom, and the next bust lasts a little longer. Over time, this cycle increases our pain and diminishes our activity.
What can we do about it?
Well, one alternative behavioural strategy we can try to implement is pacing. If we were to graph our activity levels during the boom-and-bust cycle, it’d look like a hurdle race down a hill: lots of jumps in activity, lots of flat lines in between, and everything getting gradually but steadily lower over time. With pacing, we’re aiming more for a staircase approach – small, incremental steps, that gradually and steadily lead to an increase in activity levels over time. Of course, there are still flat lines in a staircase, and there are still periods of rest in pacing, just as there are in the boom-and-bust cycle. The difference in pacing is that we take those breaks because we recognise we’re approaching our limits, not by necessity because we’ve exceeded them.
The first step in pacing is to work out our baseline for activity. Let’s take walking for an example – if you want to increase your walking capacity, you first need to determine how far or for how long you can walk without experiencing a pain flare. As soon as you feel that pain beginning to flare up, stop the activity and note how long it took. Once you know roughly how long you can walk without experiencing a flare, and you’ve tested that over a couple of days, you can work out the average. It might look something like this:
Day 1: 23 Minutes
Day 2: 19 Minutes
Day 3: 21 Minutes
Average of all 3 days: 21 Minutes.
Once you have your average, take away 20%, and you’ll end up with a number – in this case, around 17 minutes. That’s your new baseline, and you can then try to walk every day for that same duration. Don’t be tempted to increase quickly if you start to feel good, or you’ll be vulnerable to falling into that boom-and-bust cycle again. Instead, try the new activity for a week, and then if you feel OK, increase it by 10%, and repeat until you reach your goal. It’s a gradual increase, giving your body time to adjust to the new routine before you increase it. Pacing asks you to plan rest, rather than resting because you have no alternative.
It may be a long road to recovery, and we may not be able to return fully to the capacity we had prior to the arrival of the pain – but we can make things better than they are now, and that is always worthwhile.
