Footstep 10

Managing setbacks

Setbacks are very common in managing pain. Being confident to deal with them is a ‘must have’ skill for an easier time.

Setbacks can be due to many reasons – think of them a bit like what can happen to athletes in training. For athletes, a setback can be due to injury, tiredness or mental challenges. A setback with pain is similar and is often linked to tiredness, pacing difficulties or mood issues.

Sometimes a setback could be caused by changes in your medication – and sometimes for no obvious reason at all.

So let's look aty how to deal with setbacks effectively...

Managing setbacks with a setback plan

To cope better with setbacks and reduce the stress, panic or low mood that they sometimes cause, it is helpful to have a setback plan.

Thinking about a setback plan now means you’ll be more prepared for when a setback happens.

Here are some ideas for things to include in your setback plan:

Four ideas for a setback plan

1. Ease back, easy does it

Cut back on normal activities for some days. Take more, small regular breaks in the day, lie or sit down and unwind the body using relaxation breathing.

Bed rest weakens muscle strength rapidly. You lose about 1% of total muscle strength each day if you totally rest up. So keep gently active and moving to speed recovery and shorten setbacks.

Be kind to yourself. Say ‘NO’ to any big, stressful or unhelpful demands until you feel stronger and confident.

Don’t be too proud or scared to ask for help from others, support helps in setbacks!

2. Pace more and keep active

Remember to pace yourself even more. Begin gentle stretching and movement as soon as possible to regain flexibility. Start on the same day as the setback if possible! Your body will work with you if you take it gently, steadily and move often (for more about pacing, see Footstep 3).

Build up the time you spend stretching and moving. Keeping active may seem alien but don’t be put off as it really does work!

Use the effort scale (see Footstep 3) to guide activities and fitness and choose effort levels 3-5 as you manage difficult days.

3. Relaxation

Practice relaxation or mindfulness breathing (find out more about relaxation in Footstep 9).

Do things to soothe and calm you – it could be listening to music, knitting, doodling, stroking the cat or dog – whatever works for you.

4. Refocus your thinking

Tackle your thoughts. Try not to think of the setback as the ‘worst thing that can happen’. This puts your mind and the pain into a negative spiral of thought and moods.

Accept that you have a setback and that now is the time for for the setback plan. Share with yourself that “just as it came, it will settle more easily. I now have a plan to help me get back on track”. (For mroe about acceptance see Footstep 2).

A true story

In my setbacks in the past, I would end up lying on the floor, resting up all day and see the doctor again. Now I more confident in managing them and I actually go to the gym instead!

I was surprised to find that by staying active, gently stretching and exercising I actually got through my setbacks much quicker.

Here's what I do nowadays when a setback hits:

I am nice to myself and take it steady – I call them ‘easy does it’ days.

I tell myself “the setback has come, and it will go”.

I cut down all activities by about half for a few days.

I am kind to myself and give myself a treat – it’s something to look forward in a setback.

Resources for you to use

Coping with chronic pain flare-ups

Flare-ups or dramatic increases in pain levels are often part of chronic pain. How often they occur and how long they last varies from person to person. Healthtalk's website has a number of useful videos with people sharing their experiences of dealing with setbacks caused by pain flare-ups.

Maintaining progress and managing setbacks

There are many ways to maintain change and continue to build on your success and increase confidence. This leaflet, based on a section from the book Overcoming Chronic Pain, tells you how.

Managing setbacks: key ideas

  • People with pain experience setbacks for many reasons – and sometimes for no obvious reason at all
  • Having a setback plan ready can help you get back on track sooner
  • Cutting back on activity – but still being gently active – is the key
  • Using your pacing skills is more important than ever during a setback
  • Remember to be kind to yourself and that "it will pass"