Wednesday, January 24, 2018

Keeping Pain at Bay

December 31, 2017 by · Leave a Comment 

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The advice “pace yourself” is often expressed when someone appears in danger of burning out by doing too much, too fast. It’s also excellent counsel to persons trying to cope with painful or fatiguing health conditions including arthritis, chronic fatigue syndrome, diabetes, heart conditions, lupus, fibromyalgia, and depression.

Stacey L. Schepens Niemiec

The concept known as activity pacing “involves balancing periods of activity and task engagement with periods of rest, so that an individual can more easily achieve meaningful goals throughout the day,” says Stacey L. Schepens Niemiec, assistant professor of research within the University of Southern California Chan Division of Occupational Science and Occupational Therapy. “Those goals might range from being able to play with one’s grandchildren to attending a baseball game in its entirety.”

Schepens Niemiec, who holds a MS in occupational therapy and a PhD in instructional technology, relies on a multidisciplinary combination of occupational therapy, instructional technology, and gerontology principles to promote health and wellness and counterbalance chronic health problems. Her research findings are applicable to anyone battling painful and exhausting conditions that might limit participation in daily and desired activities.

Taking brief rest breaks of a certain amount of time (say 10 minutes) within an activity period is known as time-based pacing. Resting regularly, according to Schepens Niemiec, helps “avoid symptom exacerbations or condition-specific flares such as swelling or pain that over-activity might induce.” If underactivity causes symptoms such as stiffness, she suggests the alternative of “brief active periods interspersed within extended periods of inactivity.”

There is no one-size-fits-all wellness plan based on the balance of inactivity and activity. Schepens Niemiec says, “Because each person’s life will look very different from the next person’s life, it is not practical to think that a given activity pacing strategy can be properly woven into a person’s life without considering his/her personal circumstances. It really is about finding the right balance tailored to your personal needs, activities, and life circumstances.

“Underactivity may result in fatigue, pain, stiffness, and depressed mood. Over-activity might result in similar consequences depending on the condition that a person is trying to manage. In thinking about activity pacing as a subset of life balance, integrate strategies into daily habits and routines to find that ideal balance of activity to achieve maximum health and well-being.”

Even with enthusiasm and determination, achieving the proper life balance isn’t always smooth sailing. Being blown off course happens to everyone, advises Schepens Niemiec, whether it’s a “temporary barrier such as an acute illness or more major life transitions such as welcoming a new member into the family or retiring from a physically demanding job.”

The underlying condition or illness itself can also present barriers to time-based activity pacing, Schepens Niemiec cautions. “The fatigue and pain that comes with chronic conditions often involves a vicious cycle that an individual must try to break. When it comes to self-management of symptoms, a person might tend to respond to symptoms by replacing activity with long periods of rest and inactivity. The less active a person becomes, the greater the likelihood that he or she will experience worsening symptoms such as increased pain and fatigue. As those symptoms intensify, the person becomes even more inclined to limit activity. Breaking such a cycle is never easy, but it is absolutely critical for health and wellness maintenance.”

In any case, “Having a plan with clear intentions to reengage in activity when presented with a setback is helpful (provided there are no specific health contraindications).”

As special events or impromptu activities arise, using coping techniques allows you to avoid sinking your progress. Schepens Niemiec shares the story of Brenda, who needed help to integrate activity pacing into a singular experience: “Brenda rarely flies to see her grandchildren in England; however, her grandson is getting married, and she will be attending the wedding. This requires Brenda to think about the general strategies she has learned with pacing during her normal routine and apply them to symptom management on the multi-hour flight. The challenge here is not only generalizing the strategies that she knows already work, but also getting creative in applying them — it’s not as easy to take the needed 10-minute stretch break, especially in a confined space like an airplane, but is certainly possible with some outside-the-box thinking and pre-planning.”

The assistant professor gathering insight into activity pacing through research also has a personal tale about pacing’s social acceptability. Schepens Niemiec has psoriatic arthritis, a rheumatic disease that resembles rheumatoid arthritis in several ways. She relates that, “The hardest part for me during the workday was sitting through long lectures or meetings without having a break for two-plus hours. By the time they would break, I could barely stand up. Unfortunately, I did not feel comfortable interrupting guest speakers or other faculty by standing on my own accord when everyone else remained seated — I felt that it was upstaging and also made it look like I was impatient and wanted to leave.

“But with only a bit of discussion with my coworkers and management, and given that I work in the Health Promotion and Prevention Research Core of our division where we are all trying to counter sedentary behavior, we decided as a group that it was acceptable to stand quietly during any meeting or lecture. Because so many people do it now, despite them not necessarily having arthritis, I no longer feel like an outsider.”

By garnering support from those around her, Schepens Niemiec overcame a social barrier that might otherwise hold her back health- and/or career-wise.

When looking for balance, it’s also important to focus on more than the physical. “Consider a patient who has rheumatoid arthritis (RA), a condition that can be exacerbated by stress (whether it is physical stress, emotional stress, or other). In addition to a diagnosis of RA, let’s say this person has general anxiety when having to interact with strangers in social situations. Each time this person attends a social event, she inevitably feels her stress levels increase, which in turns causes a joint flare. For this person, then, pacing her social activities (or socioemotional stressors) due to the repercussions of such activity would be important,” says Schepens Niemiec.

When battling a health condition or trying to increase wellness when aging, it’s exceedingly helpful to keep track of the physical, the emotional, and outside conditions that affect you. “Seeing those patterns are not easy to do if you are only tracking them in your mind. However, when you keep a dietary journal, use a fitness tracker, or keep a mood diary, you can begin to see where your own deficits might be,” recommends Schepens Niemiec. She adds, “I also find it important to try to document, even just generally, what activities you engaged in to help find a connection between your daily life and your symptoms.”

If you are not under the care of a medical professional helping you overcome or manage your painful and fatiguing health issue, Schepens Niemiec lauds the benefits of a consultation with an occupational therapist.

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By Lita Smith-Mines



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