Managing Chronic Pain Or Fatigue – Part 1by Dr Katherine Mollart - 28th May, 2015
People who experience prolonged and severe symptoms of pain or fatigue, often try to manage it by:
1) Resting more and reducing activity in the hope of feeling better and to prevent symptoms from getting worse.
2) Pushing themselves to do as much as possible when they can, and rest more when symptoms get worse (‘all or nothing’ behaviour).
Many people use both of these strategies. They are natural, understandable ways to try to manage symptoms. However, when you rest more and reduce activity in an attempt to get better:
. Your cardiovascular system becomes unfit, resulting in symptoms including palpitations, sweating, breathlessness and fatigue.
. You lose muscle tone or strength in your legs, resulting in less blood returning to the heart. This can lead to a drop in blood pressure when you stand up, with less blood going to the brain, causing unpleasant symptoms including dizziness and fatigue.
. Your quality of sleep can be poor.
. You can lack motivation and energy.
When this happens, you are likely to reduce your activity further. You will then experience increased symptoms when you are active due to reduced physical fitness and reduced muscle strength, so you rest even more, and the cycle goes on.
Others may be over-active and push themselves on the good days, leading to a flare-up of symptoms, followed by long periods of inactivity to recover. You can then find yourself in a ‘boom and bust’ cycle.
One way of both preventing and managing fatigue and/or pain is to adopt a consistent approach to activity, sleep and rest. Pacing enables you to plan and monitor your activities so that you feel more in control of everyday life and your symptoms. Finding a helpful pacing style means:
· Reaching a balanced pattern of varied activity at a steady pace, using time or distance not your symptoms as a guide.
· Doing some activity even at times when you don’t feel like it e.g. when you are tired, in pain or feeling down.
· Not overdoing activities on better days.
· Doing the same or similar levels activity every day.
· Steadily increasing the amount you do and the types of activity over time.
The first step is to keep an activity diary over a week, writing down what you are doing hour-by-hour from when you wake up to when you go to sleep at night. This will allow you to see any problems in your pattern of activities.
Add up the total number of hours of rest that you had over the week. Rests are times such as watching TV, listening music or reading. Divide this by 7. E.g. total rest over 7 days = 21 hours, 21 / 7 = 3, amount of rest to be taken each day: 3 hours.
Your therapist at the British CBT and Counselling Service will be able to support you to do this. Part 2 will talk you through how to develop your individual activity programme. Click below to navigate.