Pacing Metaphors, Neuropathic Pain and Flexible Persistence

Paul presents two metaphors for pacing. Climbers on Mount Everest move up and down between camps to acclimatize, so coming back down still counts as training. In the rattlesnake metaphor, moving into the rattle zone and back out again can reduce threat and desensitize over time. Silbernagel's pain monitoring model allows pain up to five on a VAS after exercise, provided it settles by the next morning. Patients should be told in advance that flare-ups are likely and what they mean. Neuropathic pain involves hyperalgesia, allodynia and spontaneous pain. Studies suggest that regular, gradual exercise promotes pain relief while short rapid bouts raise the chance of flare-ups. Drawing on Christine Price, Paul notes that pacing in neuropathic pain is more about managing exposure to triggers than building up activity. Flexible persistence, based in ACT, uses values to guide activity, and when-then plans help people reach goals such as gardening without a rigid pacing schedule.