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== History == ===In ME/CFS === Pacing was developed as an energy management strategy for ME-patients in the [[United Kingdom|UK]] in the 1980s.<ref name=":8">{{Cite journal | last = Goudsmit | first = Ellen M. | last2 = Nijs | first2 = Jo | last3 = Jason | first3 = Leonard A. | last4 = Wallman | first4 = Karen E.| date = 2012 | title = Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document|url=https://www.ncbi.nlm.nih.gov/pubmed/22181560|journal=Disability and Rehabilitation|volume=34|issue=13|pages=1140–1147|doi=10.3109/09638288.2011.635746|issn=1464-5165|pmid=22181560|pmc=|quote= | author-link = Ellen Goudsmit | authorlink2 = Jo Nijs|access-date= | authorlink3 = Leonard Jason | authorlink4 = | authorlink5 = |via=}}</ref> Health psychologist [[Ellen Goudsmit]] had suffered from post viral syndrome herself<ref name=":16" /> the decade before and noticed how patients had to learn through trial and error how to pace themselves. Patients were forced to discover through their own frustrating experience how to stay as active as possible within the limits the disease had imposed upon them. This resulted in many unnecessary relapses. In order to prevent these, Goudsmit worked out her own approach into an advice that could be used by others. In the 1990s pacing was promoted in factsheets by various ME-groups in the UK.<ref name=":9">{{Cite news | url=https://www.prohealth.com/library/pacing-for-me-cfs-the-facts-23836| title = Pacing for ME/CFS: The Facts - Prohealth| date = 2007-01-17|work=Prohealth|access-date=2018-08-19|language=en-US}}</ref> Around the same time, [[Leonard Jason]], a professor of psychology at the University of Chicago who also suffered from a post-viral fatigue syndrome,<ref>{{Cite web|url=http://www.northbynorthwestern.com/story/arrested-development/| title = Feeling fatigued: studying CFS at Northwestern|website=northbynorthwestern.com|language=en|access-date=2018-08-19}}</ref> developed the [[Energy Envelope Theory|envelope theory]] along the same principles of energy conservation.<ref>{{Cite journal | last= Jason | first = L. A. | last2 = Melrose | first2 = H. | last3 = Lerman | first3 = A. | last4 = Burroughs | first4 = V. | last5 = Lewis | first5 = K. | last6 = King | first6 = C.P. | last7 = Frankenberry | first7 = E.L. | date=Jan 1999| title = Managing chronic fatigue syndrome: overview and case study|url=https://www.ncbi.nlm.nih.gov/pubmed/10205371|journal=AAOHN journal: official journal of the American Association of Occupational Health Nurses|volume=47|issue=1|pages=17–21|issn=0891-0162|pmid=10205371}}</ref> A decade earlier ME-expert Melvin Ramsay had written about the benefits of implementing sufficient rest periods: <blockquote>"One can hold out no specific cure for the illness but advice should immediately be given that they adapt their lives to a quieter tempo and take adequate periods of complete rest after physical exertion." </blockquote> === In other conditions === The term pacing has a longer history in the management of other chronic conditions, though its meaning is ambiguous. Two main traditions exist.<ref>{{Cite journal | last = Nielson | first = Warren R. | last2 = Jensen | first2 = Mark P. | last3 = Karsdorp | first3 = Petra A. | last4 = Vlaeyen | first4 = Johannes W.S. | date = May 2013| title = Activity pacing in chronic pain: concepts, evidence, and future directions|url=https://www.ncbi.nlm.nih.gov/pubmed/23247005|journal=The Clinical Journal of Pain|volume=29|issue=5 | pages = 461–468|doi=10.1097/AJP.0b013e3182608561|issn=1536-5409|pmid=23247005}}</ref> In the first, pacing is used in the context of energy conservation, a common element in the treatment of autoimmune and neurological disorders such as rheumatoid arthritis<ref>{{Cite journal | last = Furst | first = G. P. | last2 = Gerber | first2 = L.H. | last3 = Smith | first3 = C.C. | last4 = Fisher | first4 = S. | last5 = Shulman | first5 = B. | date = Feb 1987| title = A program for improving energy conservation behaviors in adults with rheumatoid arthritis|url=https://www.ncbi.nlm.nih.gov/pubmed/3565525|journal=The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association|volume=41|issue=2|pages=102–111|issn=0272-9490|pmid=3565525}}</ref> or [[Multiple sclerosis|MS.]]<ref>{{Cite journal | last = Mathiowetz | first = Virgil G. | last2 = Finlayson | first2 = Marcia L. | last3 = Matuska | first3 = Kathleen M. | last4 = Chen | first4 = Hua Yun | last5 = Luo | first5 = Ping| date = Oct 2005| title = Randomized controlled trial of an energy conservation course for persons with multiple sclerosis|url=https://www.ncbi.nlm.nih.gov/pubmed/16193899|journal=Multiple Sclerosis (Houndmills, Basingstoke, England)|volume=11|issue=5 | pages = 592–601|doi=10.1191/1352458505ms1198oa|issn=1352-4585|pmid=16193899}}</ref> Energy conservation includes balancing activity and rest, setting priorities, delegating tasks and using assistive devices such a wheelchair. This form of energy management is similar to the principles of pacing used in ME/CFS. Pacing is however more frequently used in the context of chronic pain where it has a background in operant conditioning. First described by Wilbert Fordyce in 1976,<ref>Fordyce WE. Behavioural methods for chronic pain and illness. Mosby: St. Louis; 1976</ref> pacing referred to a time-contingent and gradual increase of activity levels. Fordyce’s main idea was that chronic pain patients shouldn’t be directed by their symptoms but by plans, goals and targets. In this context, pacing referred to the careful planned route, based on positive reinforcements instead of the fear of pain, to reach those goals.<ref>{{Cite journal | last = Gill | first = Joanna R. | last2 = Brown | first2 = Cary A. | date = Feb 2009| title = A structured review of the evidence for pacing as a chronic pain intervention | url =https://www.ncbi.nlm.nih.gov/pubmed/18448368|journal=European Journal of Pain (London, England)|volume=13|issue=2|pages=214–216|doi=10.1016/j.ejpain.2008.03.011|issn=1532-2149|pmid=18448368}}</ref> Often a task was broken up into manageable parts or quotas so the patient can go forward step by step with breaks in between. Although the principles of operant conditioning are no longer central, in the chronic pain literature pacing still frequently refers to a planned and gradual increase of activity levels. Pacing means doing things “slow but steady”,<ref>{{Cite journal | last = Nielson | first = W.R. | last2 = Jensen | first2 = M.P. | last3 = Hill | first3 = M.L. | date=Jan 2001| title = An activity pacing scale for the chronic pain coping inventory: development in a sample of patients with fibromyalgia syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11166466|journal=Pain|volume=89|issue=2-3|pages=111–115|issn=0304-3959|pmid=11166466}}</ref> by splitting up activities in smaller parts, and without discontinuation if the patient is having a bad day. This form of pacing is quite dissimilar and sometimes even contrary to the form of pacing used in ME/CFS. {| class="wikitable" ! colspan="5" |Definitions of pacing used in the chronic pain literature |- |Kavanagh (1995)<ref>Kavanagh J (1995) Management of chronic pain using the cognitive-behavioural approach. British Journal of Therapy and Rehabilitation, 2(8), 413-18</ref> |Birkholtz & Aylwin (2000)<ref>Birkholtz M, Aylwin L (2000) OT in chronic pain management: a specialist area. Occupational Therapy News, 8(11), 26-27.</ref> |Strong et al. (2002)<ref>Strong J, Unruh AM, Baxter GD. Pain: a textbook for therapists. Toronto: Churchill Livingstone; 2002.</ref> |Nielson et al. (2013)<ref>{{Cite journal | last = Nielson | first = Warren R. | last2 = Jensen | first2 = Mark P. | last3 = Karsdorp | first3 = Petra A. | last4 = Vlaeyen | first4 = Johannes W.S. | date = May 2013| title = Activity pacing in chronic pain: concepts, evidence, and future directions|url=https://www.ncbi.nlm.nih.gov/pubmed/23247005|journal=The Clinical Journal of Pain|volume=29|issue=5 | pages = 461–468|doi=10.1097/AJP.0b013e3182608561|issn=1536-5409|pmid=23247005}}</ref> |Jamieson-Lega et al. (2013)<ref>{{Cite journal | last= Jamieson-Lega | first = Kathryn | last2 = Berry | first2 = Robyn | last3 = Brown | first3 = Cary A| date = 2013 | title = Pacing: A concept analysis of a chronic pain intervention | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812193/|journal=Pain Research & Management : The Journal of the Canadian Pain Society|volume=18|issue=4|pages=207–213|issn=1203-6765|pmc=3812193|pmid=23717825}}</ref> |- |“Pacing involves breaking down activities into smaller steps, resting between steps and doing small amounts regularly rather than a large amount of activity in one go.” |“Activity pacing consists of (a) changing position to time, (b) taking frequent short rests, (c) breaking tasks into manageable bits, (d) alternating positions and tasks frequently, (e) slowing down, and (f) increasing activity amounts gradually.” |“introducing tasks in a graded manner, in order for the client to build skills, confidence and tolerance for the activity, so that activity levels can be increased” |“Activity pacing is the regulation of activity level and/or rate in the service of an adaptive goal or goals.” |“Pacing is an active self-management strategy whereby individuals learn to balance time spent on activity and rest for the purpose of achieving increased function and participation in meaningful activities.” |}
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