If you live with ongoing pain or fatigue, it is normal to have good days and bad days. And it is normal to want to do as much as possible on the good days, just in case another bad day is on the horizon – unfortunately, this often leads to what is known as the ‘Boom-Bust cycle’.
If you live with chronic pain or fatigue, you might recognise yourself in this scenario:
You wake up and, for once, things feel lighter – you have slightly less pain, and you are moving easier than normal. You even feel like you have some energy. For a moment you feel almost normal again. It’s a relief — and naturally, you want to make the most of it.
You decide to get onto your ever lengthening to-do list that you keep having to postpone. So you do the washing. Tidy your cupboard. Sweep the floors. Clear the inbox. Go for a longer walk. Meet a friend for coffee. You finally feel productive again. You go to bed happy – maybe you’ve turned a corner!
And then the next day arrives.
Your body feels heavy. Your joints ache. The pain is sharper. Your brain feels foggy. You eventually drag yourself out of bed and have a shower, but that wipes you out. You cancel plans. Your pain medication makes no difference. You lie on the couch wondering why you “did this to yourself again.”
This is what we call the boom–bust cycle. On good days, it’s like you are driving a car using only the accelerator – there are no brakes! You try to catch up with everything that you haven’t been able to do due to your pain – you move the house 3 meters to the left – but the next day, it’s all brakes, no accelerator. You crash and burn, needing to rest more and being able to do even less. If the cycle continues, you end up having more bad days than good, and the bad days become harder to recover from.
The way to get out of this cycle is to drive your car using both the accelerator and the brakes in combination and in balance. Do a consistent amount of activity on good or bad days, and gradually increase the amount you do. This is called activity pacing, and it is a way to regain control.
Why pushing through so often backfires
When pain first starts, pushing through can feel like strength. It feels proactive. Determined. Resilient.
But when pain has been present for months — especially if your nervous system has become sensitised — repeated overexertion can keep the system on high alert. Your nervous system’s job is to protect you, and if you swing between very low activity and sudden bursts of high demand, it interprets this inconsistency as threat. And when your nervous system perceives threat, it does what it is supposed to – it protects you by responding defensively — with increased pain, fatigue, and shutdown.
Research has shown that overactivity — doing too much on good days — can maintain sensitivity and keep the cycle going. The nervous system prefers predictability. Large swings in activity send mixed messages: one day you do nothing, the next you sprint. Neither pattern helps the system learn that movement is safe.
Over time, you need more rest for longer periods, leading to joint stiffness, muscle weakness, decreased fitness, low mood and worsening symptoms.
When crashes feel bigger than just sore muscles
For some people, the “bust” isn’t just increased pain. It feels bigger than ‘just more pain’ – but rather like something systemic.
You may notice:
- Crushing fatigue
- Flu-like symptoms
- Brain fog
- Sensory overload
- Poor sleep
You may also notice that the crash doesn’t happen immediately — it may hit 24 or 48 hours later, which can make it hard to see the connection to what you did on your good day.
This pattern is often referred to as post-exertional neuro-immune exhaustion. In simple terms, your nervous system and immune system are closely linked, functionally and structurally, and influence each other. When a system (your nervous system) is already sensitised, an increase in physical, emotional, or cognitive effort can trigger your immune system to start an inflammatory response and makes the nervous system even more sensitive. The body shifts into protection mode, it over-responds to normal or even less than normal input, and literally forces you to stop.
The primary management strategy for the boom-bust cycle and for post-exertional neuroimmune exhaustion is activity pacing.
So what is pacing — really?
Pacing is often misunderstood as “doing less.” But the most helpful form of pacing doesn’t focus on avoidance — it focuses on consistency and regulation. Pacing means setting realistic and achievable goals that allow you to do activities every day, regardless of your pain.
Modern research supports pacing as a structured strategy that helps people manage their activity in an informed and consistent way. In fact, studies exploring new activity pacing frameworks for chronic pain and fatigue found that patients not only accepted pacing as a strategy but also reported that it helped them regulate their activities and symptoms. Many described pacing as a way to get their life back rather than feel trapped by pain.
What makes pacing effective is not slowing down randomly, but stabilising your activity in a way that recognises how symptoms fluctuate. It’s not just about resting when uncomfortable. It’s about planning activity and rest in balance, so your system learns safety and predictability.
Finding your true baseline
One of the most important — and often most difficult — steps in pacing is identifying your baseline. This isn’t what you can manage on your best day. This is what you can manage on a difficult day without triggering a significant flare the next day.
If you can walk for half an hour when you feel good but crash afterwards, that isn’t your baseline. If ten minutes feels manageable even when symptoms are higher, that may be your starting point. Being realistic about your starting point and ensuring that you achieve success is critical to using pacing effectively for self-management of pain or fatigue. A helpful question to ask yourself is: ‘How much of (activity) can I do today, without paying the price for it tomorrow?’ Humans are notoriously bad at judging their own abilities, so if your answer is 20 minutes, then decide to do even less, say 15 minutes, to ensure success.
Staying consistent — Even on good days
This is often the hardest part. When you finally have energy and feel good, everything in you wants to do more, to catch up on all that’s been put on hold. But pacing asks you to think differently — to protect tomorrow, not just enjoy today, and to stick to the plan regardless of whether you feel good or bad.
When you stop while you still feel capable, you’re sending a message to your nervous system: Activity is predictable, and nothing dangerous happened. Over time, this helps reduce perceived threat, which gradually turns the volume down on sensitivity.
Planning and Gradual Increments
Planning what, when, where and how you are going to do your activity of choice is critical to setting successful goals. The more detail you have in your plan, the greater the chances that you will stick to it. And tell someone about your plan. Having some accountability helps your nervous system understand that whatever you have decided to do is important to your safety and survival.
Once you have maintained your baseline in activity comfortably for a week or two, you can start to increase the amount you do gradually. Small increments work best: a few extra minutes of walking, one extra repetition of a task, a small extension of work time – generally a 10% per week increment is sufficient and still guarantees success. The aim is not to push through discomfort but to challenge your system in small, manageable steps.
This is how capacity quietly and steadily builds. Write down your gains and give yourself a reward for achieving your goals – celebrate the small wins! Gratitude helps your nervous system reset too!
Pacing when Neuro-Immune sensitivity is present
If your crashes feel bigger than “just sore muscles,” and you think you might be experiencing post-exertional neuro-immune exhaustion, pacing may require even more careful calibration. Post-exertional neuro-immune exhaustion means that your symptoms may be amplified by both nervous system and immune responses. In this case, pacing must be deliberate, consistent, and cautious. The goal remains the same: create stability first, then allow safe growth.
Creating stability might mean starting with a set wake-up and bed time, regular meal times and just washing your face and brushing your teeth every day. For those experiencing this degree of symptom exacerbation, your baseline might be that you rest twice as much as you are active. Pacing gradually shifts the balance to being twice as active as you rest!
When pain feels too high to even start
Sometimes people struggle to pace because background pain levels remain too high. In many persistent pain conditions, pain arises from a mix of ongoing nociceptive drivers — such as tissue irritation — and nervous system amplification. Addressing the nociceptive contributors first, whether through rehabilitation, medical management, or carefully selected procedures, can lower the baseline threat and make pacing more manageable.
Once pain intensity reduces even modestly, it’s often much easier to engage consistently in pacing and gradual activity increases. Treating pain often means calming both the inputs (such as inflammation or mechanical irritation) and the amplification mechanisms (the sensitive nervous system).
If you are unsure why your pain is so severe, or you have no clear diagnosis for your condition, you should consult a healthcare provider before deciding whether pacing will be an effective strategy for you.
Final thoughts:
Breaking the boom–bust cycle is not about giving up or doing less forever — it is about learning to drive your body differently. Pacing is the skill of using both your accelerator and brakes in balance — knowing when to gently increase activity and when to pause, regulate and protect your system so that you can keep going tomorrow.
If you recognise yourself in this cycle and would like guidance on how to apply pacing in a structured, personalised way, reach out to the healthcare team at the Pain Collective. We can help you understand your specific pain drivers, calm the sensitivity in your system, and build a realistic plan that allows you to move forward steadily — with both hands on the wheel.