Living with chronic pain can feel like navigating a constant struggle between activity, pain, and recovery. For many individuals, this battle creates a pattern of behaviour known as the “boom-bust” cycle. This cycle is characterised by periods of overactivity followed by increased pain and exhaustion, often resulting in a dramatic drop in function.
What is the Boom-Bust Cycle?
The boom-bust cycle of chronic pain is a common and understandable pattern among individuals with chronic pain. It involves alternating between periods of overdoing activities and then being forced to rest due to a flare-up of pain. This cycle often looks like this:
- Boom: On good days, individuals feel optimistic and push themselves to do more than they should, thinking that they need to catch up or make the most of a pain-free moment.
- Bust: Eventually, the body cannot sustain the increased activity, leading to a flare-up of pain, fatigue, or other symptoms, which forces the individual to rest or significantly reduce activity for a time.
- Cycle Repeat: This pattern repeats itself, creating frustration, increased stress, and often exacerbating both pain and mental health concerns like anxiety and depression (Kerns et al., 2011).
Here is a case example:
Sophie, a 38-year-old woman with fibromyalgia, experiences periods of good and bad days with her condition. On a day when she wakes up feeling slightly better than usual, she decides to take advantage of it. She spends the morning cleaning the house, running errands, and doing a few chores she’s been putting off. She feels productive and proud of what she’s accomplished, but as the afternoon progresses, she starts to feel a familiar tightness in her muscles.
By the evening, Sophie’s back pain and joint stiffness intensify, and she starts feeling deeply fatigued. She tries to push through it, thinking she can relax later, but the pain continues to worsen. She can’t sleep that night due to the discomfort, and by the next day, the pain has escalated to the point where she can barely get out of bed. Her exhaustion is overwhelming, and the pain severely limits her ability to do anything.
For the next few days, Sophie is unable to do much—she cancels social plans, doesn’t go to work, and can barely move without pain. Her function has dramatically dropped as a result of her overactivity the previous day.
How the Boom-Bust Cycle Affects Physical Health
Repeatedly overexerting oneself, followed by the necessary period of rest, can exacerbate both physical and emotional pain. In the physical realm, pushing the body too hard can increase inflammation, irritate the nervous system, and worsen pain sensitivity (Kerns et al., 2011). When the nervous system is repeatedly triggered by overactivity, it can lead to an increased sensitivity to pain or pain from stimuli that don’t typically cause pain (Schwartz et al., 2017). As a result, the individual may begin to experience pain more frequently, intensely, or from activities they were previously able to tolerate. This escalating sensitivity creates a vicious cycle, where physical activity leads to more pain, and more pain leads to greater activity limitations.
How the Boom-Bust Cycle Affects Mental Health
In the mental health domain, the cycle can lead to emotional burnout, anxiety about whether you can handle activities in the future, and feelings of frustration or failure when you are unable to keep up (Linton & Shaw, 2011). For many, the boom-bust cycle can also lead to avoidance behaviors. When an individual anticipates that pushing themselves will lead to increased pain, they may start avoiding activities altogether, which can result in deconditioning and a reduction in functional ability. This cycle, though understandable, ultimately impedes progress toward better pain management and a more fulfilling life.
An Alternative Approach: Pacing
Strategies such as pacing—gradually increasing activity and balancing rest—can help individuals with chronic pain achieve more stable, consistent function and improve both physical and emotional health. Learn more here: The Role of Pacing in Chronic Pain Management
Seek support when you need it
If you’re seeking psychological support, the team at the Centre for Clinical Psychology in Melbourne has appointments available. Our experienced psychologists are dedicated to creating a safe, supportive environment for you to explore and process life’s challenges.
Book your appointment today by calling us at 03 9077 0122 or conveniently schedule online at https://ccp.net.au/booking/.
References
Kerns, R. D., Sell, P., & Sullivan, M. D. (2011). Chronic pain and mental health. Psychiatric Clinics of North America, 34(2), 163-179. https://doi.org/10.1016/j.psc.2011.02.002
Linton, S. J., & Shaw, W. S. (2011). Impact of psychological factors in the experience of pain. Clinical Journal of Pain, 27(3), 184-191. https://doi.org/10.1097/AJP.0b013e31820465e2
Schwartz, L., Alesi, A., & Brun, L. (2017). Central sensitisation in chronic pain. Journal of Pain Management, 28(5), 47-56. https://doi.org/10.1016/j.jpm.2016.09.003
