June 3rd, 2009

Pain Management Class #3

Pain Management Class #3

In today's pain management class we learned about pacing. When we are feeling pretty good and our pain level is low, obviously we tend to want to get a lot done. All too easily this leads to overdoing it, which then leads to crashing, plunging us below our baseline and exacerbating all our symptoms. Crashing wipes us out and makes it impossible to be productive in any way. So after a recuperative period, the next good day we have makes us want to catch up and get a lot done all over again, which leads to another crash, etc. These ups and downs begin to look like a sine wave if we plot them out on a piece of paper, with big swings from the ups to the downs and back again.

The goal of pacing is to reduce the severe ups and downs and to even out the curve a little bit. There will be some natural up days and down days, of course, because that is perfectly natural and it's just a part of life, but the limits are not going to be as extreme as they would be without employing some kind of pacing.

We learned today first to look at our daily activities and break them down into 2 groups, one high-impact and one low-impact. Then we looked at keeping track of how long each high-impact activity would take until the time of inflection, or reaching the top of the curve, the point beyond which we will wind up pushing ourselves too far and trigger a pain flare. For example, I might not be able to mop the floor for more than 2 minutes before reaching my limit, or deal with meal preparation for more than 5 minutes, or clean the bathroom for more than 7 minutes at a time. Every day would be different, of course -- perhaps some days I could only manage 2 minutes of bathroom cleaning before I reached my limit, and other days it might be 15, but by keeping an activity log we would be able to find a reliable average over time.

The next thing we would have to consider is how much recovery time we need for each high-impact activity, and to use that block of time to deal with the low-impact activities on our list. In theory, by following this plan, at the end of the day all our activities will have been completed and we will not have pushed ourselves beyond the point of inflection and triggered a crash.

Now, one thing I absolutely despise doing is functioning according to the clock, following a strict timetable as though I were a mere machine that could be programmed and scheduled. I cannot imagine doing something like mopping the floor for 2 minutes, then dropping that to make phone calls for 5 minutes, then dropping that to clean the bathroom for 7 minutes, then dropping that to do a relaxation exercise for 5 minutes, then stopping that to resume phone calls for 5 more minutes, then dropping that to resume cleaning in the bathroom for 7 more minutes, then dropping that to sort the laundry for 5 minutes, then dropping that to finish mopping the floor, because by then I would be going insane from the constant interruptions and leaving a thousand unfinished chores all over the house. I've always been good at prioritizing tasks each day and making sure the most important things got done, come hell or high water. Unfinished business makes me nervous and often outright depressed. I hate loose ends.

Another thing I have problems with is stopping in the middle of something. I've found that if I can't complete it in one go, once I drop it mid-stream to deal with something else (or to crash), usually it never gets picked up again to get completed, often due to the unpleasantness of doing the task itself to begin with (but occasionally just due to exhaustion or crashing). I'm sure I've set myself up for many crashes by functioning that way, but at least the tasks got completed and my self-esteem remained intact.

Also, I just happen to have an extremely high-impact event scheduled for tomorrow where for several hours I'm not going to have the option of stopping things to take a break.

This is going to be an interesting week . . .