Pain Management

West of Scotland Chronic Pain Education Group



Should I advise activity for patients with chronic pain?

Yes, remaining active stops loss of fitness and improves physical and mental well-being

Consider referral to GG&C NHS exercise referral scheme

Consider referral to physiotherapist for assessment and advice on maintaining activity and pain relieving measures, such as TENS (Transcutaneous Electrical Nerve Stimulation) etc.

Weight loss or stabilisation may be required to maintain optimal weight doc: NHS GG&C Chronic Pain Management 2010

What is over activity cycling?

People with persistent pain often vary their activity depending on their daily pain. This results in cycles of over activity during good days, and under activity during bad days. Doing too much on good days is often followed by increased pain, forcing the person to rest. This can lead to reduced fitness, increased pain and often the individual will become fearful of activity.

This cycle will create a downward spiral in activity and further produce more pain and fear. Setting a baseline of regular activity can be difficult because many people over-estimate what they think they should be doing. People should be encouraged to do small amounts of activity on a regular basis and be advised that this activity should not exacerbate their pain. This will result in improved fitness and a greater tolerance of activity allowing the person to gradually increase what they are able to do.

How do I advise on pacing activities?

It is best to work out what an achievable duration of activity is on a poor day and set the daily target just below this for every day, that is on both good and bad days this level of activity is achievable. Breaking the task down into smaller components can also help if the patient is overwhelmed by the amount of activity.
For example:
• Doing 30 minutes of housework in the morning, and the same again in the afternoon as opposed to trying to do all the housework in one go. This 30 minute period of activity should be gradually increased over a period of weeks and months.
• Similarly, a walk could be broken down into more manageable periods and gradually built up over time.


Does psychology have a role in chronic pain management?

Referral to a pain management programme should be considered for patients with chronic pain.
Clinicians should be aware of the possibility that their own behaviour, and the clinical environment, can impact on reinforcement of unhelpful responses.