Over the next couple of days I’m going to review the coping strategies survey I’ve been running. I’ve had 33 participants, so it’s not a large sample, but it does represent some of the professions working in the field of chronic pain.
12.5% Social workers
29.2% Occupational therapists
12.5% Medical practitioners
20.8% Psychologists (health or clinical)
plus 4 ‘others’ - students mainly. You’ll see the total is more than 100% - rounding, or so I understand from SurveyMonkey!
The first set of questions related to defining three terms commonly used in pain management. I’ve just reviewed a paper about ‘pacing’, so it’s interesting to see how these participants defined it.
Question 1 - How do you define ‘pacing’?
15.2% Working to a pre-defined quota of time or activity task despite fluctuations of pain
45.5% Breaking an activity into smaller pieces rather than completing the entire task
45.5% Starting with an achievable pre-defined quota and gradually increasing this over time despite fluctuations of pain
Other responses: Breaking activity into smaller pieces, then taking breaks as needed between sections Managing activity levels so as to be doing the optimal amount in terms of managing pain levels (e.g., not doing too little or pushing yourself too hard)
I’m interested that the concept of pacing is related to pain intensity, and that half the respondents thought it should involve breaking a task down to avoid flare-ups. This definition would seem to confirm the place of pacing alongside passive coping strategies as McCracken & Samuels found, and the general lack of consensus that Gill & Brown identified in the literature (McCracken & Samuels, 2007; Gill & Brown, 2008).
Now I put this next question in as a bit of a red herring - I personally never use the term ‘task simplification’ with people. It comes from around the era of the term ‘pacing’, so probably in the mid-1970’s, and is related to conserving energy as you might do for something like multiple sclerosis, or chronic obstructive airways disease - in other words, where the person is unlikely to regain fitness. It’s been brought into pain management probably because of the relationship between early ways of coping with rheumatoid arthritis (in the same way as pacing was), although over time the management of rheumatoid arthritis has moved from reducing activity to maintaining activity despite flare-ups.
Question 2 - How do you define ‘task simplification’ to a client/patient?
42.4% Finding the most efficient way to carry out a task
3.0% Deciding whether a task needs to be carried out at all
36.4% Breaking a task into smaller parts
18.2% Reducing the demands of a task so that it can be carried out without flaring pain up
I don’t - I think it infers avoidance.
Task persistence is a term that isn’t often used by patients in relation to managing their pain - but is one skill that health professionals might consider important. I think it forms part of activity management because in order to increase overall activity tolerance, it’s necessary to persist over the existing ‘limit’ to a certain extent. Task persistence often needs to be used within a work situation in order to meet a deadline, achieve an outcome, or make it through to the end of a working day!
Question 3 - How do you describe ‘activity persistence’ or ‘task persistence’ to a client/patient?
15.2% Continuing with an activity until it is completed
51.5% Continuing with an activity until the pre-determined quota is reached, despite fluctuations in pain
36.4% Completing as much of an activity as is possible but not so pain flares up
Other Comments: I don’t use this term Pain may increase (within tolerance) but calms down on stopping activity
This is the first part of my survey - more tomorrow on when to use different types of coping strategy. If you’ve enjoyed reading this post, and want to know more - you can click on the RSS feed link above, or you can bookmark this blog and come on back! Don’t forget to comment (I love them - it makes me feel wanted!), and let me know what you think or what you want more of.
J GILL, C BROWN (2008). A structured review of the evidence for pacing as a chronic pain intervention European Journal of Pain DOI: 10.1016/j.ejpain.2008.03.011
McCracken, L. M., & Samuel, V. M. (2007). The role of avoidance, pacing, and other activity patterns in chronic pain. Pain Vol 130(1-2) Jul 2007, 119-125.