The role of avoidance, pacing, and other activity patterns in chronic pain

The level and pattern of daily activities performed by persons with chronic pain are regarded as central determinants of their overall physical, social and emotional functioning. Within the chronic pain literature, various approaches to activity are typically considered, including activity avoidance, "pacing", and particular patterns of high rate activity, sometimes referred to as "overuse" or "activity cycling". Of these, activity avoidance has been most studied, while the others remain poorly understood. The purpose of this investigation was to examine distinct activity patterns of chronic pain sufferers, and to consider their relations with physical, social, and emotional functioning. Based on data from 276 individuals with chronic pain, four distinct activity patterns were identified with cluster analysis. Correlation and group comparison analyses confirmed that patients who avoid activity suffer greater physical disability and distress. Surprisingly, pacing activity was positively related to avoidance and disability. Patients who reported relatively high activity in conjunction with little avoidance demonstrated distinctly better physical and emotional functioning than other groups. Pain did not distinguish groups to a large extent but acceptance of pain did. Groups with the most avoidance and disability reported the lowest levels of acceptance of pain. These data suggest that activity patterns are complex and multidimensional, and that avoidance appears to be the overriding process with regard to daily functioning. Moreover, avoidance patterns may be subtle, sometimes resembling healthy coping, and sometimes presenting along side patterns of high activity.