Fibromyalgia Symptom Management - The Importance of Pacing *An Article By: Dave Leach* Fibromyalgia is known for its disabling symptoms of widespread chronic pain and fatigue. If you have Fibromyalgia, then you know how severe these symptoms can be. However, the severity of your symptoms may vary greatly over time. Some days you feel okay, others you don’t. Here is an effective strategy to help manage your symptoms so you have more good days than bad, and you may also find your bad days are more manageable. Striking this ‘balance’ is the goal of good symptom management. A program of symptom management should always include an element of “pacing”. This is extremely helpful in managing both pain and fatigue and is probably the single hardest thing you will need to learn how to do! Pacing doesn’t mean waiting until you are worn out to stop what you are doing. It means setting a schedule of activity and rest. Sometimes only a few minutes each. Then you gradually increase your activity until you find the right balance between activity and rest. Most importantly, you do this for everything you do, even when you feel well. Now, be honest. When you have a good day what do you do? You run around the house trying to catch up on all the housework. You stay a little extra longer at work to finish up that project. You go out with your family for a whole day in the park. Or maybe a big shopping trip. You just plain overdo it! Then what happens? You CRASH BIG TIME, right? You spend the next few days in bed or on a strictly reduced schedule. STOP! This is not the way to manage your symptoms. Experts agree that learning to pace your activities by alternating between periods of rest and activity is the proper way. Now, this doesn’t mean just when you are feeling poorly. The key to this strategy is to pace yourself when you are feeling good! This way you won’t cause a flare-up by doing too much. So how do you do this? Here are some basics you can implement today and improve your symptom management through pacing. 1. Start Using a Stopwatch or Timer. Learn to pace your activities by the clock. To start, set your timer for five minutes or longer if you think you can do the activity that long. When the timer rings it’s time to change positions or rest. You can gradually increase the intervals of activity and rest as you learn what your endurance level is. 2. Change positions: If you are sitting, stand for a few minutes and vice versa. 3. Stretch: At least twice an hour, do a little mild stretching. People with fibromyalgia need to be cautious about overdoing it with stretching. By this I mean “intensity” rather than frequency. Our muscles respond to extreme stretching by contracting even more. The way to avoid this is to stretch mildly – just until you feel the muscle extend. Easy does it is best. Ask your doctor or physiotherapist to recommend some good stretching exercises. (You can do a lot of stretching while sitting.) 4. Set A Schedule: Plan out your activities for the next week. Don’t overbook your schedule. Plan time for rest, personal time, family time, as well as work – if you are still working. Remember, your schedule doesn’t have to be written in stone. You can always change it. Now that you have a schedule, try to stick to it. Some people find it best to make a schedule one day at a time. In this case, it may be best to create your schedule the night before or first thing in the morning. 5. Prioritize: You may find your schedule was too much to follow. Don’t despair! This is a learning opportunity. Make a list of the things you want to accomplish and assign each task a number according to its importance. Then, when you make your schedule you can spread the tasks out over time. Don’t try to do all the important tasks all at once. Also, don’t put too many strenuous tasks together. Plan for rest breaks. Remember, you’re pacing yourself. 6. Split tasks into smaller bits: Do you have to wash all the dishes at once? Do you have to put them all away right after washing? Same with vacuuming. Instead of doing the whole house, do one room each day! Learning to split these jobs up into smaller chunks is an important part of pacing. 7. Learn To Delegate: This can be really challenging for some of you. Asking for help is not always easy. But for many people with fibro, it’s a necessary part of symptom management. Try to enlist the help of family members. This might cause some friction at first, so it is vital that you first explain why you need their help. Get some information on Fibromyalgia and print out some copies to hand out. Then go through it together. Once they more fully understand the situation, they may be more willing to help. 8. Learn to say NO: This is tough to do, I know. We often feel bad when we have to refuse someone’s request. An easy way to say “no” gracefully is “I’m sorry, but my schedule is really full right now. I don’t like to say yes and then not be able to fulfill my obligation and let you down.” They’ll understand that your refusal is partly because you don’t want to disappoint them and it’s not against them personally. Some of you may be asking, “Well how can I pace myself at work?” Granted, your boss may not like you taking a 5-minute break for every 5 minutes you work! It may just be that your symptoms are so severe you might have to reduce your work schedule or maybe even stop working all together! This can be a very difficult decision. You may want to consider working from home as an alternative. Some employers now offer this option. As well, the Internet provides you with many work from home opportunities. This is not for everybody. You do need some computer skills and the self-discipline to stick with it. Some of you may not even be well enough to work from home. But it could be something to work towards. Learn to pace yourself using the strategies outlined above. You may just find you can handle one or two hours of work at your computer each day. However, if you must work outside the home, then planning your pacing schedule and using the above strategies becomes even more important. You will definitely need to delegate more, learn to say “No” to many things, and not overcrowd your schedule. Managing your symptoms of fibromyalgia through pacing is not always easy, but if done properly you will find that you will actually reduce the amount of “down” time and get more done. Remember…easy does it!