Activity Pacing, Avoidance, Endurance, and Associations With Patient Functioning in Chronic Pain: A Systematic Review and Meta-Analysis

Andrews, Neil; Strong, Jennifer; Meredith, Pamela

doi:10.1016/j.apmr.2012.05.029

Cited by 163 publications

(199 citation statements)

References 83 publications

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“…Whether pacing is indeed helpful, though, remains unclear [16]. A recent meta-analysis found weak correlations with pain and physical disability, but also with better psychological functioning [3]. This meta-analysis, however, included studies in which breaks may have also been pain-contingent.…”

Section: Discussionmentioning

confidence: 99%

Interrupted by pain: An anatomy of pain-contingent activity interruptions

Gatzounis¹,

Schrooten²,

Crombez³

2014

Pain

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Section: Discussionmentioning

confidence: 99%

Interrupted by pain: An anatomy of pain-contingent activity interruptions

Gatzounis¹,

Schrooten²,

Crombez³

2014

Pain

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“…The relatively controlled and simplified situation of cycling a time trial against a competing opponent while monitoring pacing behavior can provide new insights in how exercisers regulate their exercise intensity, supporting the suggestion that not only internal, but also external information is incorporated in the decision at what intensity to exercise [2]. A better understanding of the decision-making process involved in pacing behavior could even contribute to our general understanding of the way people pace their activities in daily life or how exercise intensity is regulated when achieving demanding goals in a rehabilitation context [4].…”

Section: Introductionmentioning

confidence: 99%

The behavior of an opponent alters pacing decisions in 4-km cycling time trials

Konings

Schoenmakers

Walker

et al. 2016

Physiology & Behavior

109

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Please cite this article as: Konings Marco J., Schoenmakers Patrick P.J.M., Walker Andrew J., Hettinga Florentina J., The behavior of an opponent alters pacing decisions in 4-km cycling time trials, Physiology & Behavior (2016), doi: 10.1016/j.physbeh.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. An interaction effect for condition x distance (F=3.944, P<0.001) indicated differences in pacing profiles between conditions. Post-hoc analysis revealed that a less aggressive starting strategy was adopted in NO compared to OP-FASTSLOW and OP-SLOWFAST during the initial 1000m. Finally, a faster starting opponent evokes higher power outputs by the participants in the initial 750m compared to a slower starting opponent. Conclusion: The present study is the first to show that the behavior of an opponent affects pacing-related decisions in laboratory-controlled conditions. Our findings support the recently proposed interdependence of perception and action, and emphasize the interaction with the environment as an important determinant for an athlete's pacing decisions, especially during the initial stages of a race. Highlights The pacing behavior of an opponent alters pacing decisions of an athlete in labcontrolled conditions  A faster starting opponent evokes a faster start compared to a slower starting one. The behavior of an opponent is an important determinant for an athlete's pacing decisions, which is thus far often overlooked in investigating pacing behavior.

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“…Individuals who are habitually overactive identify with being hardworking and successful, 7 but high levels of overactivity have been quantitatively linked to more self-reported physical disability, perceived difficulties participating in certain daily activities, and poorer psychological functioning. 3,5 As many of the participants in this study had been experiencing pain for an extended period of time, the observed association may be more reflective of habitually overactive individuals being less likely to cease opioid therapy after its initiation. Qualitative findings by Andrews et al 7 provide support for this idea as some habitually overactive participants in their study reported reliance on opioid medication to function effectively and inability to reduce opioid medication usage despite receiving encouragement, and guidance on how to do so, during a multidisciplinary pain management program.…”

Section: Discussionmentioning

confidence: 87%

“…3,15,35 Some authors have argued that self-report measures may be more reflective of paincontingent behaviour than quota-contingent behaviour as items from existing measures do not provide a specific reason why, or context in which, an individual is using a pacing strategy. 3,37,38 Other authors have suggested that activity pacing, as a stand-alone treatment, encourages adaptation to an illness, as opposed to ameliorating an illness (which is the goal of a combined operantbased pacing and graded activity program). 54 Because of this, the pacing subscale was not used in this study.…”

Section: Self-reported Habitual Approach To Activity Engagementmentioning

confidence: 98%

The relationship between overactivity and opioid use in chronic pain

Andrews

Strong

Meredith

et al. 2016

Pain

Self Cite

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With increasing concerns about the potential harm of long-term opioid therapy, there is a need for the development and implementation of alternative treatment strategies for patients with chronic pain who have been using opioids for a prolonged period of time. Based on the findings from a recent qualitative investigation that suggested there may be a bidirectional association between opioid reliance and habitual overactivity behaviour (activity engagement that significantly exacerbates pain), this study was designed to quantitatively investigate the association between opioid use and habitual overactivity over a 5-day period in a group of chronic pain patients. Participants provided a list of their prescribed pain medication, completed a self-report measure of habitual overactivity, and then commenced 5 days of data collection. Data collection required participants to wear an activity monitor and to complete a diary that detailed their daily activities and the time at which they took medication. Individuals reporting higher levels of habitual overactivity were more likely to be prescribed opioids. In addition, higher levels of habitual overactivity were associated with more frequent pro re nata ("as needed") opioid use over the 5 days, and with a discrepancy between the prescribed and actual oral morphine-equivalent daily dose, where more medication was taken than was prescribed. There was no predominant context for pro re nata use. The results of this study support the idea that habitual overactivity behaviour may play a role in the development of reliance on opioid medication and that such an association may provide a potential treatment target for opioid therapy rationalisation.

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Activity Pacing, Avoidance, Endurance, and Associations With Patient Functioning in Chronic Pain: A Systematic Review and Meta-Analysis

Cited by 163 publications

References 83 publications

Interrupted by pain: An anatomy of pain-contingent activity interruptions

Interrupted by pain: An anatomy of pain-contingent activity interruptions

The behavior of an opponent alters pacing decisions in 4-km cycling time trials

The relationship between overactivity and opioid use in chronic pain

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