This practical worksheet introduces pacing as a behavioral strategy to help clients with chronic pain engage in consistent, manageable activity.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
Clients with chronic pain often fall into a 'boom and bust' cycle – doing too much when they feel well and suffering increased pain afterward. This pattern can result in reduced physical fitness, low mood, and greater vulnerability to further injury. Pacing offers a structured alternative: engaging in regular activity based primarily on time rather than being driven solely by symptoms.
This resource supports clients in learning how to find their baseline activity level and gradually increase it. It presents psychoeducational material, baseline calculation, and guidance for overcoming common difficulties.
Pacing helps clients manage chronic pain more effectively by promoting behavioral consistency and improving function.
Clients experiencing persistent pain and activity avoidance.
Helping reintroduce activity in a paced and manageable way.
Introduce pacing as a technique to improve function and reduce pain flare-ups.
Identify a specific activity (e.g. walking, standing, housework) the client wants to pace.
Ask the client to time themselves doing the activity over several days, including both good and bad days.
Average the times and subtract around one-fifth as a cautious starting baseline.
Encourage consistent engagement at the baseline level, even when pain fluctuates.
Use reminders (e.g. timers or alarms) to encourage adherence to breaks and stopping at the right time.
Monitor progress and increase activity as the client’s tolerance improves.
The pacing technique is grounded in behavioral models of chronic pain, which identify cycles of overactivity followed by withdrawal. Clients often avoid activity due to fear of pain, or push themselves excessively when they feel well — both of which can contribute to increased pain and disability over time.
Pacing teaches clients to base activity primarily on time rather than being driven solely by pain. This consistent approach can help reduce pain-related fear, build physical tolerance, and improve overall functioning. It sits comfortably within cognitive-behavioural frameworks and is particularly useful for clients who struggle with cognitive distortions around “pushing through.”
Therapists should anticipate and address barriers such as perfectionism, fear of appearing ‘lazy,’ and guilt over taking breaks.
Working...