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If you have CFS or fibromyalgia, you are probably acquainted with the experience of push and crash. This is the frustrating loop in which people swing between overactivity and forced rest, feeling caught in the vicious cycle illustrated in the diagram.
When their symptoms are low, they push to get as much done as they can and the overexertion triggers an intensification of symptoms, which in turn leads to forced rest or a crash (Overexertion => Increased Symptoms => Rest). The high level of symptoms leads to the need for rest (the crash).
Resting is usually successful in reducing symptoms but then, frustrated by all they hadn’t done while resting, they plunge into another round of overactivity to catch up (Reduced Symptoms => Frustration => Overexertion), leading to another crash.
The Push/Crash Cycle
Living in response to symptoms, they are caught in a vicious and often demoralizing cycle in which high symptoms alternate with periods of extended rest and their lives feel out of control.
Post-Exertional Malaise (PEM)
There is another, very important consequence of push and crash. Not only does overdoing produce an intensification of symptoms called Post-Exertional Malaise or PEM, but the intensification is out of proportion to the overdoing.
People with CFS and FM are in a doubly difficult situation. First, they have much less energy than healthy people (on average, about one quarter as much). And, second, activity beyond their limits triggers a disproportionate increase in symptoms.
It’s not unusual for an hour of extra activity to trigger a half day or more of bed rest and a higher level of symptoms that lasts a week. Going beyond limits for several days can lead to several weeks in bed and can reverse several months’ gains. In sum, even small amounts of overactivity can produce severe consequences.
Pacing
Pacing offers an alternative to repeated cycles of push and crash, namely the possibility of a more stable life. With pacing, you can live your life according to a plan, rather than in response to symptoms, giving you a sense of managing the illness, rather than the illness controlling you.
The benefits of pacing include:
- Lower symptoms
- Less suffering
- More predictable life
- Sense of control
- Less time spent resting (because less PEM)
- More productive use of time (because less PEM)
- Chance for improvement
Pacing has three parts:
1 Finding Limits
Fibromyalgia and CFS impose limits, which vary from modest to severe. Some are limits on physical activity, such as cooking, cleaning, doing laundry, shopping, driving, standing, exercise and work. But there are limits in other areas as well, including limits on mental activity, socializing, stress, and exposure to sensory information, food and other substances.
2 Adapting
The second part of pacing is adjusting one's life to fit within curent limits. Adjustment is a gradual process, involving the use of multiple strategies, as described on upcoming pages. The reward is reducing the suffering of Post-Exertional Malaise.
3 Extending Limits
If you pace consistently, you may be able to expand your limits, doing more without intensifying your symptoms. The keys to expanding limits are to extend them a little bit at a time and to return to your previoius level if the extension increases your symptoms.
Summary
The key point is that how you live your life with CFS and/or fibro has a big effect on your symptoms. Push and crash leads to a life controlled by fluctuations in symptoms. But by using pacing to find and adjust to your limits, you can reduce symptoms, regain a sense of control, and may be able to expand your limits.
How important is pacing? Here’s what Dr. Lapp said in a 2015 webinar for patients conducted by the CDC (US Centers for Disease Control and Prevention):
I cannot emphasize enough how important pacing or limit setting is to the person with CFS/ME [or FM]. Pacing is more important than any medication, more than any supplement, more than Valcyte, or rituximab, or even Ampligen!
Supplements only optimize one’s health. Medications only treat the symptoms, and there is no cure for CFS/ME [or FM] at this time. Years of experience have taught me that pacing and limit setting are key to improvement and recovery.
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