Overdoing or Underdoing: Activity levels in chronic pain

**Nate** · #1 07-30-2009, 01:23 PM

Overdoing or Underdoing: Activity levels in chronic pain

Posted on March 24, 2009 by adiemusfree

"By a strange coincidence, after writing about regulating activity levels yesterday, I came across a pre-print editorial in the European Journal of Pain discussing exactly this: avoidance or persistence.
We’ve become quite familiar with the avoidance idea – avoidance leading to deactivation, leading to disability, loss of roles, depression and so on. There have been several models to explain this, most recently Vlaeyen’s pain-related anxiety and avoidance model which implicates an underlying negative affectivity, health anxiety and catastrophising, and ultimately leading to kinesiophobia, or fear of movement. Treatments arising from this model include graded exposure, along with reduced physiological arousal and cognitive restructuring around catastrophising.
What has been discussed much less often is the ‘boom and bust’ pattern I described yesterday, and the even less frequently discussed ‘overdoing’ group of people. In the ‘boom and bust’ group, people seem to pursue activity to a high level, then stop to ‘recover’, returning to a high level of activity only to need to stop to recover again. This pattern can lead to a gradual decline in activity as the high level of activity gradually reduces over time – notably when pain is used as a guide for how much and how long activities are carried out.
In the overdoing group, the pattern seems to be one of consistently pushing to complete activities throughout the day, only to become exhausted at night, sleep poorly and begin the busy-ness the next day. Sometimes this continues for a long time, only to subside in deactivation when the person reaches exhaustion, becomes depressed, or sustains another illness.
The problem with both of these activity patterns is ..."

Click on the link to view the ful article:

http://healthskills.wordpress.com/2009/03/24/overdoing-or-underdoing-activity-levels-in-chronic-pain/

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