Dr Deborah Antcliff

Improving care for people with chronic pain or fatigue

A new research study run by Bury’s Integrated Pain Service could improve care for people with chronic pain or fatigue.

The study is testing a new guideline to standardise how healthcare professionals advise patients to pace their activities to help manage conditions such as chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

Activity pacing has been used for many years but there are currently no agreed standards – and there’s even some debate into whether pacing may worsen symptoms as well as improve them.

Activity pacing covers a range of techniques, including breaking down large tasks into smaller sections, switching between activities, incorporating rest breaks as needed, setting goals, planning activities and having more consistent levels of activities so patients don’t try to do too much one day, only to suffer for it the next.

The aim is to prevent flare-ups of symptoms and to encourage patients to safely and gradually build up their activity so they can enjoy a better quality of life.

But sometimes urging people to ‘take things slow and steady’ or ‘take rests whenever you need to’ can make them feel negative about being active so they start avoiding the activity instead.

Dr Deborah Antcliff, a physiotherapist at the Northern Care Alliance NHS Group who works with the Bury Integrated Pain Service, has been awarded funding under Health Education England/National Institute for Health Research’s prestigious Integrated Clinical Academic programme to develop the study. Her academic work is supervised by the University of Leeds.

She said: “Activity pacing is a well-established coping strategy for managing persistent pain and fatigue but at present we don’t have an evidence-based framework to guide healthcare professionals, which means different people are using different approaches. We need to identify the best approach to take so we can achieve the most effective results for our patients.”

The new Bury Integrated Pain Service, which brings together physiotherapists, psychological medicine, pain consultants and pain nurses, sees patients take part in a six-week programme of classes which include activity pacing, graded exercise, mindfulness, sleep advice and other techniques.

Dr Antcliff has drawn up the framework following a survey of health professionals and refined it with the help of patients. She and colleagues are now testing it in the pain service, measuring changes in symptoms for patients who take part and also interviewing some of them to gather their opinions.

Around 50 patients will be involved, with checks before and after the six-week course and again three months later.

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