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Pacing:
What It Is and How to Do It
Controlling Relapses: A Five-Part
Strategy
By Bruce Campbell
Times
of intense symptoms, often called flares, setbacks or relapses, are a
common and often demoralizing part of Chronic Fatigue Syndrome and
fibromyalgia. In addition to creating additional pain and discomfort,
they can be deeply troubling, creating the worry that you will never
gain control over your illness or have a chance at lasting improvement
are possible.
This
article offers a five-part strategy to help you cope with the unevenness
of your illness, and its physical and psychological effects. You can
apply the ideas to your life using the Relapse Worksheet, available on
our Logs and Forms page.
1)
Identifying Relapse Triggers
The
first step to gaining control over your flares is to identify those
things that trigger setbacks. While flares are sometimes due to the
waxing and waning of your illness, many setbacks are caused by factors
over which you have some control. These factors could be actions you
take or events that happen to you. In any case, they are things that
consistently intensify your symptoms. Keeping a health log can help you
identify your triggers.
Five
triggers often mentioned by people in our program are:
 | Overactivity:
Probably the most common cause for a flare is living “outside the
energy envelope.” The body responds with higher symptoms when its
limits are ignored.
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| Poor
Sleep: Non-restorative sleep can
intensify symptoms and precipitate a vicious cycle in which symptoms
and poor sleep reinforce one another.
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| Other
Illnesses: Coming down with an acute illness or having multiple
chronic illnesses make flares more difficult to avoid and more
severe when they occur.
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| Stress:
CFS and fibromyalgia are very stress-sensitive and sources of stress
are numerous. We may intensify setbacks by our expectations for
ourselves or by our reactions to stress.
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| Special
Events: Vacations,
holidays and other special events can trigger flares. Non-routine
events require more energy than everyday life, temporarily shrinking
the energy envelope at a time when you may want to be more active
than usual. (For more on special events, see the next
article in this series.) |
Completing
the relapse triggers part of the form provides you with a list of your
vulnerabilities. The example is offered as a starting point.
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Relapse Triggers
Doing too much (outside energy
envelope)
Poor sleep
Secondary illnesses
Staying too long in one position
Travel
Doing more than one thing at a time (multi-tasking)
Financial problems
Stressful relationships (particular people)
Food or chemical allergies
Light or sound (sensory overload) |
2)
Spotting Relapse Warning Signs
Warning
signs are the signals your
body sends that indicate you are heading toward a flare. Using a list of
warning signs like the one below, you can train yourself to notice when
a flare is about to occur. If you respond by taking corrective actions
(see the next section), you may be able to avoid a flare entirely or at
least reduce its severity. By filling out the form, you are expressing a
commitment to heed, rather than ignore, signs of impending trouble. The
example below contains signals people in our program often list.
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Relapse Warning Signs
Feel especially weak, dizzy, confused or tired
Extra pain
Stiffness
Feeling stressed out
Cranky
Sleepy
Anxious
Eating junk food |
3)
Responding to Warning Signs
Because
it is easy to ignore signs of trouble, it helps to have a plan in place
telling you what to do when warning signs appear. Having such a plan can
help you to retrain yourself away from ignoring the signals of your body
and in the direction of being responsive to its needs. By taking action
in response to the warning signs, you may be able to avoid a flare or at
least reduce its length and severity. Here’s a list of possibilities.
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Responses to Warning Signs
Lie down (get extra rest)
Postpone, delegate or eliminate tasks
Simplify: no multi-tasking
Stretch
Practice a relaxation procedure or take a bath
Limit sensory input (e.g. TV)
Limit time with other people |
4)
Minimizing Relapses
If,
in spite of your best efforts, you find yourself in a flare, what can
you do to limit its severity and duration? Here are six ideas to
consider.
| Respond
Immediately: You may
be able to reduce the length of a setback or even end it by taking
action as soon as symptoms begin to intensify. A member of one of
our groups said, “As soon as I begin to feel edgy, nauseous or
tired or have muscle pain (all indicators that a relapse is
imminent), I stop whatever I'm doing, go to my bedroom, draw the
blinds and lie down…Usually I arise refreshed and energetic, and
can resume all normal activities.”
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| Take
Extra Rest: The most
common strategy for overcoming setbacks is to take extra rest,
continuing until the flare subsides. As one student in our program
said, “When relapses occur, for whatever reason, I tell myself
just to go with what my body is telling me to do: rest! If I have
some things planned for that day, I try to tell myself that they
will wait for another time.”
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| Postpone,
Delegate or Eliminate: Reducing
activity by postponing tasks, asking for help or even letting go of
something as unnecessary can help speed the end of a setback. One
person in our program said, “Asking for help if I cannot do it all
or just letting go of the less important things that I am unable to
do at the time helps me reduce stress and my setbacks.”
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| Plan
Ahead: Having things
handy and in place can help reduce the anxiety of a crash and make
it easier to weather. One person told us that she keeps a large
supply of food in the house, including food that her husband and
children can cook.
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| Seek
Consolation and Support: Because
relapses can be deeply discouraging, it can help to say soothing
words to yourself, such as “this flare will end, just like all the
others.” Self-reassurance can help you relax and quiet the inner
voices that insist you’ll never get better. Talking to someone you
trust can be helpful because of the suggestions you receive, because
of the reassurance you get or just from feeling connected to another
person.
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| Return
to Normal
Slowly: Long periods of rest can create frustration as
you think about all the things you want to do, but can’t because
of your symptoms. This frustration can lead to resuming a normal
activity level before the body is ready, leading, in turn, to
another relapse. The final strategy for limiting the impact of
relapses is to return to a normal activity level gradually, resting
more than usual for several days after the relapse seems to have
ended.
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Minimizing Relapses
Go to bed as soon as possible
Let go of tasks to focus on rest
Have easy-to-cook foods family can cook
Use positive self-talk
Call friends to stay connected
Take extra rest for several days after flare seems over |
5)
Preventing Relapses
The
last step in controlling flares is preventive: your personalized list of
lifestyle habits you can use to avoid flares. To get you started, here
are six favorites from people in our program.
| Pace
Yourself: Probably the
most powerful strategy
for bringing stability to life and preventing setbacks. Pacing means
adjusting activity to the limits imposed by illness. It often
involves strategies such as short activity periods, shifting among
different activities, and having daily and weekly routines.
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| Take
Regular Rests: Scheduled
rests, done on a regular basis, can smooth out your daily life. In
addition, taking extra rest before, during and after special events,
like vacations and the holidays, or after a secondary illness can
help you avoid setbacks or limit their severity.
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| Keep
Records: Writing
a health log helps
you if two ways. First, it enables you to define your energy
envelope by providing a detailed understanding of your limits.
Second, records can serve as a source of motivation, documenting
your progress and showing the connection between overactivity and
increased symptoms.
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| Make
Mental Adjustments: Many
of the coping techniques that help limit flares require new habits
and behaviors, but their foundation lies in new, lowered
expectations for yourself that, in turn, are based on acceptance of
limits.
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| Honor
the Body’s Signals: There is a strong temptation to respond to
the onset of symptoms by “pushing through.” Creating the habit
of listening to and obeying the body’s signals can prevent
problems.
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| Be
Assertive: Standing
up for yourself can help you meet your body’s needs and reduce
stress.
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How
to Avoid Relapses
Stay within my energy envelope
Go to bed at the same time each night and get up at the same time in the
morning
Take rests every day
Have realistic expectations of myself
Stretch regularly
Take pain and sleep medications faithfully
Ask others for help
Avoid noisy places (sensory overload)
Have at least two pleasurable activities every day
Practice relaxation and stress reduction every day
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Resources
For
a printable version of the Relapse Worksheet (and all the logs, forms
and worksheets discussed on this site), go to the Logs
and Forms page.
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