Pacing Activity with Chronic Pain
A worksheet for replacing the boom-and-bust pattern of chronic pain with time-based pacing: finding a baseline, setting activity quotas, and building them up gradually regardless of how the pain feels on the day.
About this resource
Many people with chronic pain fall into a cycle of overactivity on good days followed by days of enforced rest, sometimes called boom and bust. Activity is governed by pain: on a low-pain day the person tries to catch up on everything, pain flares, and they rest until it settles, by which time fitness and confidence have slipped a little further. Over months the overall level of activity falls while pain and disability rise.
Pacing replaces pain-contingent activity with time-contingent activity. The person identifies a baseline for a given activity that they can manage on a bad day without a flare, usually well below what they do on a good day, and commits to that amount every day. Once it is comfortable, the quota is increased by a small, planned step. Because the schedule is set in advance and does not change with pain, the nervous system gets consistent evidence that the activity is safe, and the person regains a sense of control. This approach is a core component of CBT for chronic pain and of multidisciplinary pain programs, and it sits comfortably within an ACT framework when quotas are tied to valued activities.
This worksheet takes the client through recording their current pattern, choosing activities to pace, setting a baseline, planning increases, and monitoring. The professional version adds guidance on calculating baselines from a week of diary data, handling flares and setbacks without abandoning the plan, and negotiating with clients who see pacing as giving up.
How to use it
- Introduce pacing after the client understands the fear-avoidance and sensitisation ideas (see Understanding Chronic Pain). Draw their own boom-and-bust pattern on paper using a recent week.
- Ask the client to keep a simple activity and pain diary for a week before setting baselines, noting how long they did key activities and what happened afterwards.
- Choose two or three activities that matter to the client. For each, set a baseline at roughly eighty percent of what they can manage on a bad day. It should feel too easy. That is the point.
- Agree the size and timing of increases, typically ten to twenty percent every few days to a week, only when the current quota has been comfortable for several days running.
- Plan for flares in advance. During a flare the quota is held or dropped by one step, not abandoned, and then rebuilt. Review the log each session and adjust.
- Link the plan to what the client wants back. Pacing feels like restriction unless it is clearly the route to a valued goal.
References
- Nicholas, M., Molloy, A., Tonkin, L., & Beeston, L. (2011). Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain (3rd ed.). ABC Books.
- Otis, J. D. (2007). Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach, Therapist Guide. Oxford University Press.
- Nielson, W. R., Jensen, M. P., Karsdorp, P. A., & Vlaeyen, J. W. S. (2013). Activity pacing in chronic pain: Concepts, evidence, and future directions. Clinical Journal of Pain, 29(5), 461-468.
- Fordyce, W. E. (1976). Behavioral Methods for Chronic Pain and Illness. Mosby.
