A flexible approach to pacing
: What is the relationship between psychological flexibility, activity pacing and physical functioning in chronic pain?

  • Christopher MacKellar

Student thesis: Doctoral Thesis


Background: Instruction in activity pacing is a frequently featured pain management intervention in multidisciplinary approaches to chronic pain. Despite receiving widespread endorsement from practice guidelines, clinicians and patients, empirical evidence regarding the benefits of pacing has been inconsistent and inconclusive. A literature search of correlational pacing research published over the last decade was conducted to provide an up-to-date review of the evidence base and to explore the suggestion that the goal of pacing influences the outcome. The review provided preliminary evidence for this idea, which then raises the possibility that pacing may operate through other variables to influence pain outcomes. Building on this, recent qualitative studies have indicated that pacing may be related to and may interact with another important variable in pain management, psychological flexibility. Therefore, this study was designed to confirm whether a quantitative relationship exists between these variables and examine possibility that psychological flexibility mediates the relationship between pacing and pain outcomes.
Method: A cross-sectional questionnaire study was conducted to examine this hypothesis. A sample of 146 adults living with chronic pain were recruited from third-sector organisations in the UK which support individuals with pain conditions. Participants completed measures of activity pacing, process measures of psychological flexibility, pain intensity, physical functioning and provided information about their demographic and pain characteristics. A mediation analysis using bootstrapping procedures was performed to examine whether psychological flexibility mediated the
relationships between activity pacing and pain outcomes (pain intensity and pain interference).
Results: The analysis revealed that use of activity pacing strategies was significantly associated with lower pain interference, and that this relationship was fully mediated by psychological flexibility. Use of activity pacing was also found to be significantly associated with pain intensity, with higher activity pacing associated with higher pain intensity. However mediation analysis did not provide evidence that this relationship was mediated by psychological flexibility.
Conclusions: The results of the current study provide the first evidence to date demonstrating a quantitative relationship between activity pacing and psychological flexibility variables in chronic pain. Furthermore these results suggest that the primary process by which activity pacing influences pain outcome is through increasing psychological flexibility. Future research is required to replicate this finding in other samples using designs that support stronger conclusions around causation. However the findings have important implications for how pacing interventions are understood and delivered in research and clinical practice.
Date of Award1 Oct 2022
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorAlan Robert Bowman (Supervisor)

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