Self-Efficacy Versus Overactivity

For some patients, the ability to move forward and live life as fully as possible — self-efficacy — can be a positive quality and should be encouraged. But how much activity is too much?

“Within the avoidance-endurance model of pain, we suggest that pain-related endurance shown [by] mild levels of pain represents an adaptive strategy, presumably sharing some features with self-efficacy. Pain persistence despite high levels of pain tends to physical overload with the consequences of damage to physical structures in the long term,” said Hasenbring.

How can a clinician recognize damaging levels of overactivity? “We want individuals with chronic pain to be persisting with daily activities and to have meaningful life roles. When assessing overactivity in clinical settings, one should question how often pain exacerbations are experienced, how much does the pain level increase, how this affects function, and how long it takes to recover from a these pain aggravations,” Andrews said.

Activity Pacing in Pain Management

The findings of these studies suggest that learning to pace activities is important and effective but not easy. Clinicians should be aware that just handing out educational activity on pacing is probably not enough to help a person with overactivity behavior. Less than half of the participants who learned to pace their activity level were able to do so without continuing support from a health care professional. A previous study found that mindfulness-based cognitive therapy was a helpful addition.1

The principles of activity pacing are fairly simple. The key is to break the cycle of rest, overactivity, and pain by replacing it with alternating periods of rest and activity.