Integrating the 4 P’s into life with persistent pain

If you deal with pain and discomfort on a daily basis, everyday tasks can be challenging. The 4 P’s: prioritizing, pacing, planning, and positioning - provide four different paths to  help you effectively manage and navigate persistent pain in your everyday life. Learn more about the four P's below:

What is prioritizing?

Prioritizing means being focused on which tasks are most meaningful to you.

What does prioritizing entail?

Task importance: By outlining what tasks are important to you, you can plan to complete tasks at the most optimal times. This will ensure that you are minimizing the aggravation of pain and maximizing energy.

When you look at what is meaningful to you, look at the activities and tasks that you value. By outlining your priorities, you give yourself a starting point for what needs to be done. Once your priorities are outlined, the planning and pacing strategies below will help you ensure that the most important tasks you have outlined are achievable.

What is pacing?

Pacing involves the ability to proceed with tasks at a tempo that is right for you.

What does pacing entail?

Pacing strategies include:

Taking breaks: Breaks can include taking a rest, watching Netflix, or calling a friend. Breaks are important to manage pain during tasks.

Energy conservation strategies: If you are feeling an increase in pain for over two hours after your daily activities, this could be a sign that they were too heavy or challenging for you. Next time, try incorporating more breaks and splitting up heavy or challenging tasks into smaller more manageable ones.

Breaking down larger activities: Larger activities tend to be the heavy tasks - like mowing the lawn or cleaning the house, and can be more demanding to complete. An effective way to manage larger activities is to break them down into smaller tasks which can be done over a longer period of time to avoid burnout.

If are experiencing more pain as you proceed through tasks, this does not mean you have to stop what you are doing. Continue on with your tasks but when the pain reaches a point where you feel the task is not safe to continue, stop and take a break.

Better and worse days: In terms of pain, there are days that will be better and days that will be worse. On better days, it is common that people overexert themselves resulting the aggravation of pain. To avoid this, ensure you are taking breaks, splitting up activities, doing self-check-ins and letting your pain be your guide. It is important to space out activities, even the lighter ones, on worse days to prevent yourself from overdoing it.

What is planning?

Planning focuses on how you schedule your day, and allocate time for breaks, rest, and relaxation. By successfully planning ahead, you are able to ensure that your day or week is laid out in a way that is optimal to your pain management.

What does planning entail?

Task rotation: Task rotation involves switching between heavy and light tasks. By completing heavy tasks one after another, it is easier to overexert yourself. Try completing a heavy task followed by light, resting or relaxation tasks to ensure you give yourself a break during your day.

Examples of the types of tasks

Challenge:

• Heavy tasks: Mowing the lawn, carrying laundry, and cleaning the house.
• Light tasks: Writing a grocery list or folding clothes.

Rest:

• Watching Netflix or calling a friend

Calming or relaxation:

• Breathing techniques, body scan and journaling.

Some tools you can use to plan your day effectively:

• Phone calendar.
• Google calendar.
• Reminders app.
• Paper planner.
• Daily to do list.
• Home calendar.

What is positioning?

Positioning looks at different ways of doing tasks to promote safety, minimize aggravating positions, and create choice. You can change what you do with your body and change your environment. Adaptive equipment can help reduce the strain on the body and foster alternative positions that may be beneficial for your pain care. Altering the environment you live in can promote a living space that is more conducive to daily tasks which can aid in pain care.

Here are two things you can try for positioning:

1. Adaptive equipment

• Sock-aid
• Long handled reacher.
• Adaptive jar openers.
• Long handled vacuums.
• Long handled mops/dusters.                                                                

2. Adapting the environment

• Kitchen suggestions: keep frequently used items on counter, lighter items above and heavier items below. Try to when possible, especially during food preparation and cooking.
• Laundry suggestions: use a low-level position (sit, kneel or crouch), use smaller bottles of detergent, and sit to fold and iron clothes. 

Future direction

These strategies are not a complete list of everything you can do to manage your pain. However, they do outline some practical ways to help you manage pain in the performance of everyday tasks.

Feel free to start your journey by incorporating any of the above strategies into your daily activities. If you are not certain how to proceed and want to schedule an appointment with an occupational therapist, book online or find a clinic near you.

This blog was written by Justin Gilmour, a 2^nd year occupational therapy student at Queen’s University.