Becoming an active participant in your pain management

Chronic pain can make you feel like you're losing control of your life. But research is clear: people who actively engage in managing their pain have better outcomes than those who passively wait for someone to "cure" them.

This article presents concrete strategies that you can apply today. None of them are magic, but together they can make a real difference.

Active approaches vs. passive approaches

The difference that changes everything

What is done to you—massage, manipulation, medication, electrotherapy. These may provide temporary relief, but generally do not produce lasting change on their own.

What you do—exercise, stress management, lifestyle adjustments, cognitive strategies. These are the ones that produce the best long-term results.

The ideal approach is often a combination of both: passive approaches to help you get started, and active approaches to maintain your gains.

Movement: Your best ally

Why move when you're in pain?

It may seem counterintuitive, but movement is one of the most powerful tools for managing chronic pain:

• It activates your natural pain modulation systems
• It reconditions your body
• It shows your nervous system that movement is safe.
• It improves your mood and sleep
• It increases your confidence in your abilities

How to move smartly

If you have been inactive for a long time, start with 5-10 minutes of light activity. Walk, swim, or simply move gently.

Increase the volume and intensity in small increments. The 10% per week rule is a good general guideline.

Do not alternate between hyperactivity and collapse.

A little pain during exercise does not mean you are hurting yourself. The goal is to stay within a manageable range, not to avoid all sensation.

Each person has a capacity for activity that their tissues can tolerate without problems—this is your "functional envelope." When you are in pain, this envelope temporarily shrinks. The goal is to stay within this envelope while gradually expanding it over time.

Gradual exposure

If you have avoided certain movements out of fear, gradual exposure is the key strategy:

• Identify the movement or activity you are avoiding
• Break it down into small steps
• Start with the easiest version
• Gradually progress toward the full version
• Celebrate every milestone

A physical therapist can guide you through this process safely.

Pacing: Managing your energy

The boom and bust cycle

Many people with chronic pain alternate between:

• Boom: When the pain subsides, we overcompensate to make up for lost time.
• Bust: We pay the price with a surge of pain and a collapse.

This cycle keeps your nervous system in a state of hypervigilance and perpetuates the pain.

The pacing strategy

Pacing involves maintaining a stable and predictable level of activity:

Decide in advance what you are going to do, rather than letting yourself be guided by your current level of pain.

Rather than doing everything at once, divide it into manageable portions with breaks.

Stop before you get exhausted, even when you feel fine.

Do roughly the same amount of activity every day, rather than extreme highs and lows.

Practical example

Monday: Complete deep cleaning (4 hours)

Tuesday-Thursday: Collapsed on the couch because of the pain

Friday: Feeling better, starting the cycle again

Monday: 30 minutes of cleaning, break, 30 minutes

Tuesday: 30 minutes of cleaning, break, 30 minutes

... and so on

Sleep: An underestimated pillar

Why sleep matters

Poor quality sleep:

• Amplifies pain perception
• Reduces your ability to manage it
• Affects your mood and energy levels
• Keeps your nervous system alert

The vicious cycle is common: pain disrupts sleep, and poor sleep increases pain.

Strategies for better sleep

• Regular bedtimes and wake-up times
• Cool, dark, and quiet room
• Limit screen time 1-2 hours before bedtime
• Avoid caffeine after noon
• Avoid alcohol before bedtime

• Find comfortable positions (support pillows)
• Relaxation techniques before bedtime
• Don't stay awake in bed for too long.

Consult a professional. Severe sleep disorders may require specialized evaluation.

Breathing and relaxation

Why it works

Stress keeps your nervous system in "alert" mode, which amplifies pain. Relaxation techniques activate the parasympathetic nervous system ("rest and recovery" mode), which can:

• Reduce muscle tension
• Reducing pain perception
• Improve sleep
• Reduce anxiety

Diaphragmatic breathing

A simple but effective technique:

• Sit or lie down comfortably.
• Place one hand on your chest and the other on your stomach.
• Breathe in slowly through your nose—your belly should rise, not your chest.
• Exhale slowly through your mouth
• Repeat for 5-10 minutes.

Practice regularly, not just when you are in pain. It is training for your nervous system.

Other techniques

• Progressive muscle relaxation: Contract and then relax each muscle group.
• Mindfulness meditation: Observing your sensations without judgment
• Visualization: Imagine a calm and safe place.

Managing your thoughts

The power of beliefs

Your thoughts and beliefs directly influence your experience of pain. Catastrophic thoughts ("This is terrible, I can't stand it") amplify the perception of danger and therefore the pain.

Cognitive strategies

When the pain increases, what thoughts come to mind spontaneously? Identifying them is the first step.

• Is that really true?
• What is the evidence?
• Is there another way of looking at the situation?

Rather than dwelling on what you cannot change, focus on the actions you can take now.

Acceptance does not mean resignation. It means ceasing to fight against reality so that we can act effectively.

Social support

Don't remain isolated

Isolation is a major aggravating factor in chronic pain. Maintain social connections:

• Improves mood
• Reduces pain perception
• Provides meaning and motivation

Strategies

• Communicate with your loved ones about what you are going through
• Maintain social activities, even if adapted
• Join support groups if available
• Accept help when it is offered

When to consult a professional

Physical therapy for chronic pain

A physical therapist trained in pain management can:

• Assess your overall condition
• Guide you through a tailored exercise program
• Teaching you pacing and gradual exposure strategies
• Work on the psychosocial factors that contribute to your pain

The interdisciplinary team

For complex pain, an interdisciplinary approach may involve:

• Physiotherapist
• Family doctor or pain specialist
• Psychologist specializing in pain
• Occupational therapist
• Nutritionist

Building your "toolbox"

Customize your strategies

Not all strategies work equally well for everyone. The goal is to build your own "toolbox" — a set of strategies that you can use depending on the situation.

For flare-ups of pain

• Diaphragmatic breathing
• Heat or ice (whichever provides relief)
• Gentle movements
• Distraction through an enjoyable activity
• Reminder: "It will pass, just like the other times."

On a daily basis

• Smooth movement
• Pacing of activities
• Sleep routine
• Stress management
• Social connection

Key takeaways

• Active approaches produce the best long-term results.

• Movement is a powerful tool — start small, progress gradually

• Pacing avoids the boom and bust cycle that perpetuates pain.

• Sleep is essential — prioritize sleep hygiene

• Breathing and relaxation calm the nervous system.

• Your thoughts matter — cognitive strategies reduce threat perception

• Social support is protective

• Build your personalized toolbox

Whether your pain affects your back, neck, shoulders, or knees, these principles apply. You have more power than you think.

Additional resources

• Understanding chronic pain
• The neuroscience of pain
• The psychology of pain
• Acute pain vs. chronic pain
• Physical Therapy: Everything You Need to Know