A structured review of the evidence for pacing as a chronic pain intervention

Abstract

Pacing as an intervention appears with great regularity in the chronic pain management literature and yet what service providers actually mean by pacing is unclear and poorly defined. This short communication reports the findings of a structured review of the literature which examined the strength of the evidence for pacing as an intervention for people with chronic pain. The McMaster critical review guidelines were followed and the relevant electronic databases were searched. Findings revealed a paucity of outcome studies specific to pacing as an intervention. Although background literature demonstrates that pacing is often one part of a multidisciplinary intervention program, the research conducted on these programs presents pacing itself as an ill- or undefined construct. It is evident from this review that "pacing," while a widely employed term, lacks consensus of definition and a demonstrable evidence-base.

Interrupted by pain: An anatomy of pain-contingent activity interruptions

“…Whether pacing is indeed helpful, though, remains unclear [16]. A recent meta-analysis found weak correlations with pain and physical disability, but also with better psychological functioning [3].…”

“…This meta-analysis, however, included studies in which breaks may have also been pain-contingent. The effects of pacing as a technique learned in pain management programs have not been systematically examined, and when they have, the breaks employed have not been adequately described [16,25]. In order to better understand the effects and mechanisms of activity pacing, interruption characteristics, such as the type of interruption cue, must be considered.…”

“…Indeed, the frequent attempts of chronic pain patients to regulate and schedule their breaks, rather than taking them in response to pain [16,25,26], suggest that pain-contingent interruptions can be experienced as disruptive.…”

Direct and Indirect Benefits Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews

“…This use was associated with a common pain management strategy known as "pacing" or "activity management" which involves a planned alternation of physical and sedentary activities, sometimes linked with a change of posture, for example lying down. 31,32 These periods of planned rest typically form part of a daily routine. Preemptive rest may be used in this way to facilitate activity which follows the rest period, and this is made reference to in the extracts below.…”

Physiotherapists’ experiences of activity pacing with people with chronic musculoskeletal pain: an interpretative phenomenological analysis

“…Eor example, there is no consensus as to whether activity pacing reduces or increases disability (Karsdorp and Vlaeyen, 2009;McCracken and Samuel, 2007;Nielson, Jensen, and Hill, 2001). However in spite of there being no agreement regarding its efficacy, activity pacing is widely used and felt to be helpful in the management of people with chronic pain (Gill and Brown, 2009). …”