Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Pacing
(section)
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
=== In the treatment of chronic pain === While pacing is a highly endorsed clinical strategy in the treatment of chronic pain, empirical evidence to support its effectiveness is currently lacking. Raichel et al. for example found that pacing was correlated with higher levels of pain interference in 157 patients with spinal cord injury.<ref>{{Cite journal | last = Raichle | first = Katherine A. | last2 = Hanley | first2 = Marisol | last3 = Jensen | first3 = Mark P. | last4 = Cardenas | first4 = Diana D. | date = Sep 2007| title = Cognitions, Coping and Social Environment Predict Adjustment to Pain in Spinal Cord Injury|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2045649/|journal=The journal of pain : official journal of the American Pain Society|volume=8|issue=9 | pages = 718–729|doi=10.1016/j.jpain.2007.05.006|issn=1526-5900|pmc=2045649|pmid=17611163}}</ref> In a study by Ersek et al. pacing was positively associated with physical disability and pain intensity in the elderly.<ref>{{Cite journal | last = Ersek | first = Mary | last2 = Turner | first2 = Judith A. | last3 = Kemp | first3 = Carol A. | date = Nov 2006| title = Use of the chronic pain coping inventory to assess older adults' pain coping strategies|url=https://www.ncbi.nlm.nih.gov/pubmed/17074625|journal=The Journal of Pain: Official Journal of the American Pain Society|volume=7|issue=11 | pages = 833–842|doi=10.1016/j.jpain.2006.04.002|issn=1526-5900|pmid=17074625}}</ref> Kindermans et al. reported a correlation between pacing and higher levels of disability and symptoms of depression. According to the authors, “this seems to suggest that pacing, as it is currently measured, might reflect a (hidden) form of avoidance behavior.”<ref>{{Cite journal | last = Kindermans | first = Hanne P. J. | last2 = Roelofs | first2 = Jeffrey | last3 = Goossens | first3 = Marielle E. J.B. | last4 = Huijnen | first4 = Ivan P.J. | last5 = Verbunt | first5 = Jeanine A. | last6 = Vlaeyen | first6 = Johan W.S. | date = Oct 2011| title = Activity patterns in chronic pain: underlying dimensions and associations with disability and depressed mood | url =https://www.ncbi.nlm.nih.gov/pubmed/21704568|journal=The Journal of Pain: Official Journal of the American Pain Society|volume=12|issue=10|pages=1049–1058|doi=10.1016/j.jpain.2011.04.009|issn=1528-8447|pmid=21704568}}</ref> Using accelerometers to track activity levels, Cuperus et al. were able to demonstrate in a more objective manner that pacing was associated with lower activity. This led the authors to conclude that “activity pacing might not only be ineffective, it might even be potentially harmful, as inactivity-related comorbidities increase the risk for mortality and negatively influence quality of life.”<ref>{{Cite journal | last = Cuperus | first = Nienke | last2 = Hoogeboom | first2 = Thomas J. | last3 = Neijland | first3 = Yvette | last4 = van den Ende | first4 = Cornelia Hm | last5 = Keijsers | first5 = Noël Lw| date = Nov 2012| title = Are people with rheumatoid arthritis who undertake activity pacing at risk of being too physically inactive?|url=https://www.ncbi.nlm.nih.gov/pubmed/22327885|journal=Clinical Rehabilitation|volume=26|issue=11|pages=1048–1052|doi=10.1177/0269215512437417|issn=1477-0873|pmid=22327885}}</ref> In a 2012 review Andrews et al. concluded that “pacing was generally linked to better psychological functioning but more pain and disability.”<ref>{{Cite journal | last = Andrews | first = Nicole E. | last2 = Strong | first2 = Jenny | last3 = Meredith | first3 = Pamela J. | date = Nov 2012| title = Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis|url=https://www.ncbi.nlm.nih.gov/pubmed/22728699|journal=Archives of Physical Medicine and Rehabilitation|volume=93|issue=11|pages=2109–2121.e7|doi=10.1016/j.apmr.2012.05.029|issn=1532-821X|pmid=22728699}}</ref> Since then, several explanations have been put forward to explain these bleak results. Susan Murphy argued that there might be a difference between how patients and clinicians view pacing. According to Murphy patients' intrinsic view on pacing is mostly symptom-contingent and directed at reducing pain, while those of clinicians is time-contingent and aimed at increasing activity levels.<ref>{{Cite journal | last = Murphy | first = Susan Lynn | last2 = Kratz | first2 = Anna Louise | date = Dec 2014| title = Activity pacing in daily life: A within-day analysis|url=https://www.ncbi.nlm.nih.gov/pubmed/25267209|journal=Pain|volume=155|issue=12|pages=2630–2637|doi=10.1016/j.pain.2014.09.028|issn=1872-6623|pmc=4353388|pmid=25267209}}</ref> An appropriate assessment of pacing should thus occur after instructions by a clinician, to account for these differences.<ref>{{Cite journal | last = Murphy | first = Susan L. | last2 = Clauw | first2 = Daniel J. | date = Jun 2010| title = Activity pacing: what are we measuring and how does that relate to intervention?|url=https://www.ncbi.nlm.nih.gov/pubmed/20381246|journal=Pain|volume=149|issue=3 | pages = 582–583|doi=10.1016/j.pain.2010.03.031|issn=1872-6623|pmid=20381246}}</ref> Murphy also suggested pacing should be tailored to the individual patient by using physiological measures obtained during an exercise test, as targets.<ref>{{Cite journal | last = Murphy | first = Susan L. | last2 = Lyden | first2 = Angela K. | last3 = Smith | first3 = Dylan M. | last4 = Dong | first4 = Qian | last5 = Koliba | first5 = Jessica F. | date = Nov 2010| title = Effects of a tailored activity pacing intervention on pain and fatigue for adults with osteoarthritis|url=https://www.ncbi.nlm.nih.gov/pubmed/21218677|journal=The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association|volume=64|issue=6 | pages = 869–876|issn=0272-9490|pmc=3655423|pmid=21218677}}</ref> Her ideas were tested in a large trial of 193 patients with osteoarthritis, but once again results were disappointing. Both the general and tailored pacing group, were worse off than the patient group receiving usual care.<ref>{{Cite journal | last = Murphy | first = Susan L. | last2 = Kratz | first2 = Anna L. | last3 = Kidwell | first3 = Kelley | last4 = Lyden | first4 = Angela K. | last5 = Geisser | first5 = Michael E. | last6 = Williams | first6 = David A. | date = Jul 2016| title = Brief time-based activity pacing instruction as a singular behavioral intervention was not effective in participants with symptomatic osteoarthritis|url=https://www.ncbi.nlm.nih.gov/pubmed/26963847|journal=Pain|volume=157|issue=7|pages=1563–1573|doi=10.1097/j.pain.0000000000000549|issn=1872-6623|pmc=4912409|pmid=26963847}}</ref> Because some studies<ref>{{Cite journal | last = Nielson | first = Warren R. | last2 = Jensen | first2 = Mark P. | date = Jun 2004| title = Relationship between changes in coping and treatment outcome in patients with Fibromyalgia Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/15157683|journal=Pain|volume=109|issue=3|pages=233–241|doi=10.1016/j.pain.2004.01.002|issn=0304-3959|pmid=15157683}}</ref><ref>{{Cite journal | last = Cane | first = Douglas | last2 = Nielson | first2 = Warren R. | last3 = McCarthy | first3 = Mary | last4 = Mazmanian | first4 = Dwight | date = May 2013| title = Pain-related activity patterns: measurement, interrelationships, and associations with psychosocial functioning | url =https://www.ncbi.nlm.nih.gov/pubmed/23247000|journal=The Clinical Journal of Pain|volume=29|issue=5 | pages = 435–442|doi=10.1097/AJP.0b013e31825e452f|issn=1536-5409|pmid=23247000}}</ref> did find positive results for pacing in the treatment of chronic pain conditions, Deborah Antcliff argued that the term pacing, denotes several different aspects. In the Activity Pacing Questionnaire (APQ), the questionnaire she helped develop, 5 factors were differentiated: activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance.<ref>{{Cite journal | last = Antcliff | first = Deborah | last2 = Campbell | first2 = Malcolm | last3 = Woby | first3 = Steve | last4 = Keeley | first4 = Philip| date = Sep 2015 | title = Assessing the Psychometric Properties of an Activity Pacing Questionnaire for Chronic Pain and Fatigue|url=https://www.ncbi.nlm.nih.gov/pubmed/25908522|journal=Physical Therapy|volume=95|issue=9|pages=1274–1286|doi=10.2522/ptj.20140405|issn=1538-6724|pmc=4556956|pmid=25908522}}</ref> Research by Antcliff suggested that adjustment, acceptance and progression were associated with worsened symptoms, while consistency was correlated with improved symptoms.<ref>Antcliff DC. (2014). [https://www.escholar.manchester.ac.uk/api/datastream?publicationPid=uk-ac-man-scw:227500&datastreamId=FULL-TEXT.PDF The development of an activity pacing questionnaire for chronic pain and fatigue.] Phd thesis. Faculty of Medical and Human Sciences, University of Manchester. </ref> This has pushed Antcliff to promote the use of a time-contingent graded increase in activity levels, as an essential element in the definition of pacing.<ref>{{Cite journal | last = Antcliff | first = Deborah | last2 = Keeley | first2 = Philip | last3 = Campbell | first3 = Malcolm | last4 = Woby | first4 = Steve | last5 = Keenan | first5 = Anne-Maree | last6 = McGowan | first6 = Linda | date = Jul 2018| title = Activity pacing: moving beyond taking breaks and slowing down | url =https://www.ncbi.nlm.nih.gov/pubmed/29396652|journal=Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation|volume=27|issue=7|pages=1933–1935|doi=10.1007/s11136-018-1794-7|issn=1573-2649|pmc=5997723|pmid=29396652}}</ref>
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs