Chronic pain self-help guide

Work through a self-help guide that uses cognitive behavioural therapy (CBT) to help you live with chronic pain.

Section 1 of 18

1. Introduction

Urgent help

This self-help guide is intended for people with mild-to-moderate mental health issues.

If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

For an emergency ambulance phone 999.

Chronic pain affects millions of people in the UK, so you’re not alone. It can have a huge impact on your quality of life, and can also affect the lives of your family and those around you.

This guide offers a number of techniques for helping you manage your pain, and improve your quality of life.

How to use the chronic pain self-help guide

Working through this guide can take around 30 to 40 minutes, but you should feel free to work at your own pace.

Work through the guide on your device, using the “Next” button to move forward and use the “Previous” button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

If you’d like to save the guide and return to it later, you’ll need to save it as a PDF on your device before you leave the page. You can then continue filling it out on the PDF. We don’t use a login feature on our mental health self-help guides for privacy reasons.

If you’d like to print the guide at any time, you’ll find an option to save and print the whole guide, including the parts you have added, in each section.

Section 2 of 18

2. Understanding chronic pain

Pain is an unpleasant experience that happens when a part of your body is damaged, or could potentially be damaged – for example, if you twist your ankle, the pain stops you from using it and making the damage worse.

Chronic pain is pain that’s lasted longer than 3 months after the usual recovery period for an injury or health condition. It can also be caused by a long-term condition. Pain can start with a definite problem at a specific time, or it can come on gradually for no obvious reason. It can even come on some time after an event – you might manage an activity at the time, and then feel pain afterwards.

You might feel the pain in a specific part of your body, or it could feel like it’s everywhere. The pain can be there all the time, or it can come and go. Sometimes you might feel more sensitive to pain, and sometimes it can flare up – meaning it can become very bad – or get worse quickly and unexpectedly.

Even if you do things like take medication or rest, chronic pain might not go away. Pain is actually supposed to help you – it tells you not to use a part of your body that’s damaged, so it gives it a chance to heal. It’s like an alarm system in your brain, warning your body not to harm itself. With chronic pain, that alarm keeps going off even after the danger of further injury is gone.

It’s not really understood why this happens, but we do know that over time it’s possible to manage chronic pain so it doesn’t have such a big impact on your life.

How pain affects your feelings and thoughts

Living with chronic pain can affect a number of areas of your life, in a lot of different ways.

Home and work life

  • You might find you have less energy to do the things you enjoy.
  • It can be stressful to manage work, home, and other commitments when dealing with pain.
  • It might be harder to concentrate on work or study when dealing with pain.
  • You might struggle to get enough sleep, leaving you tired and struggling to cope.

Anxiety and fear

  • You could feel anxious or scared about what’s causing the pain, and worried about damaging your body.
  • Many people feel worried about the future, and about living with pain for a long time.

Other challenging emotions

  • You could find yourself being irritable with the people you care about due to the pain.
  • You might feel hopeless or down about the pain, which can lead to depression.
  • Some people feel angry – either with people they meet who don’t understand the pain, or with the pain itself.
  • Others feel angry with themselves – they see pain as a sign of weakness, and resting up as “lazy” or “letting the pain win”.

Section 3 of 18

3. How feelings and thoughts affect pain - Activity 1

The way people think and feel about pain affects how they experience the pain, and also how they cope with it. If you feel pain every time you perform a task or activity, it’s unlikely that you’ll continue with it, or do that activity again.

This exercise will show you how the way you think about pain can make a difference to the way pain affects you.

Fill in the boxes below about a time you experienced pain, and how you felt about it.

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4. Coping with pain

People cope with chronic pain in different ways. Often you’ll find that some things you do are helpful, while others can be less helpful.

We’re going to look at three different ways of coping with pain, using examples and exercises. You might not find they all match you exactly, but it’s worth working through all three exercises, as many people use a variety of coping techniques.

Pushing through pain

Some people try to “push through” the pain, and refuse to “let the pain win.” This means that they often end up feeling worse, and able to do less than they would have if they’d spent some time resting.

Anne refused to stop and rest – she had work to do and children to look after, and her motto was “no pain, no gain”.

She often felt low, upset, and frustrated with herself and the pain. By the time Anne went back to her doctor to seek more help, she was managing to do very little, and felt like giving up.

Line graph with time on the X axis and activity on the Y axis. Line travels in a zigzag motion from top left corner to top right corner, before dropping dramatically to the bottom right corner. This illustrates a consistently high level of activity over time, that suddenly drops.

Later on in this guide, we’ll look at spacing out your activities to avoid pushing too hard. It’s important for keep your activity levels as stable as possible, without doing too much or too little.

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5. Avoiding pain

Patterns often develop as people try to manage their pain and perform day-to-day activities. Some people feel trapped or controlled by their pain, so they use a lot of energy trying to avoid it.

Sandra had been dealing with chronic pain for a while, and felt like she couldn’t keep trying to “beat the pain”. She started avoiding doing too much in case the pain flared up – she felt she could manage the pain, even if she wasn’t very active. By the time she discussed the pain with her doctor again, she had a poor quality of life, often felt low and sad, and felt overall more tired and less able to do things she enjoyed.

Line graph with time on the X axis and activity on the Y axis. Line travels in a zigzag motion from top left corner to bottom right corner, illustrating that activity levels decrease over time.


Later on in this guide, we’ll look at how you can increase your activity in a manageable way, so you are able to enjoy life more without worrying about making your pain worse.

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6. Up and down

Some people do more on good days, and only rest on bad days. Sometimes this means you get a lot done on good days, but end up having a bad day afterwards. This makes it hard to plan anything, and can leave you feeling as if you aren’t in control of your life. Your activity levels go up and down all the time.

Jim wanted to get things done when he had less pain, because activities were easier and he had more energy. Sometimes he did quite a lot on a good day. However, he usually had a bad day the next day, or a few days later. On bad days, he’d rest and recover until the pain got better, and then he’d start doing a lot again. Jim found it hard to make plans, and stopped doing any activity immediately if he felt the pain starting. He went back to his doctor and said he felt like he didn’t get to decide what he did – it was the pain making the choice for him.

line graph showing activity level as low and increasing and decreasing slightly over time, but staying low overall

Later in this guide, we’ll talk about finding a balance and making sure your activity levels are stable, so the pain isn’t in control.

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7. Managing your pain

It’s very helpful to take an active interest and be involved in managing your pain, so you can break the vicious cycle of feeling worse and doing less.

Some people feel pain all or most of the time, and it’s always in the background. It can be difficult for them to cope when it flares up. It’s important to learn the things that make your pain worse – often called pain “triggers” – so you can find ways to manage them. It’s better to take a balanced approach to being active, so you don’t do too much or too little.

Pacing activities

Pacing is a technique to help people gradually reach the right level of activity for them. The right level’s different for everybody, so you can find a way of pacing and spacing activities that works for you.

We’ve already talked a bit about good and bad days earlier in this guide. Pacing is about breaking the pattern of being active on good days and stopping on bad days – instead, you can stay at around the same level of activity all the time.

It should be possible to pace almost any activity, even if it’s hard or feels strange at first.

If there’s an activity that you find difficult to pace, try our problem solving guide. It can help you consider new ways of doing things and fitting positive changes into your life.

How to pace an activity:

Choose an activity

  • Pick something that you find difficult, but not impossible.
  • If you can, make it an activity you enjoy that also makes you feel like you’ve achieved something, like going out for a walk.

Work out how long you can do the activity for without pain flaring up

  • This can take some time to get right, so don’t worry if it’s difficult at first.
  • At this point, only focus on how long you can do the activity for – so for example, if you want to go for a walk, don’t worry about the distance. Focus on time only.

Practice the activity regularly

  • Try to do the activity every day.
  • Try to practice on both good days and bad days.

Gradually build up the amount of time

  • Decide on a slightly longer time.
  • Start doing the activity for this longer time.
  • Keep building up the time until you’re comfortable and can do as much of the activity as you’re happy with.

Section 8 of 18

8. Spacing activities - Activity 2

Spacing an activity means breaking it down into manageable parts, and taking a break between doing each one. By dividing up tasks like this, you can keep an eye on how you feel and how the task is going.

How to space an activity:

Choose an activity

Pick something that you find difficult to do at the moment.

For spacing, it could be a good idea to pick an activity you feel you have to do, like housework or cooking.

Break the activity down into parts

Try to think about each step involved in the activity you want to do.

For example, Mandy wanted to cook a meal from scratch. She broke the activity into the following steps:

  1. Getting the ingredients together and laying them out on the kitchen counter
  2. Getting all the tools she needs – pots, pans, knives, and the chopping board
  3. Chopping the vegetables
  4. Seasoning the meat

And so on. Mandy listed everything that she wanted to do to cook the meal.

Think about when you can take breaks

There are going to be places in each activity where you can’t take a break – for example, Mandy wouldn’t be able to sit down for too long after putting on the oven, or the food would burn.

Plan the places on your list when you can comfortably take a break without worrying about the next step.

Use this table to plan out your activity and break times.

Take the first step

Do the first thing on your list.

Even if you feel like you don’t need a break, rest between each activity on your list. The idea is get into the habit of spacing and get comfortable with it, so you can always finish an activity without pain getting significantly worse.

Over time, your activity level should look more like this:

line graph showing activity levels that are low gradually rising over time to be moderately high

Section 9 of 18

9. Thinking about pain

When dealing with chronic pain, a lot of people struggle with unhelpful thoughts and patterns of thinking. This can make it more difficult to manage their pain and develop healthy habits for dealing with it.

Patterns of unhelpful thinking

Knowing the common patterns that unhelpful thoughts follow can help you recognise and challenge them before they have a negative effect on the things you do.

Here are some common patterns of unhelpful thinking:

Emotional reasoning

This means treating emotions as if they’re facts.

For example:

  • “I feel like I’m lazy – I must be useless.”


People often catastrophise when they’re worried about pain and its effect on their lives. They can feel like something that’s happened is far worse than it really is.

For example:

  • “I wasn’t able to meet my friend because I had a flare up – they’re going to stop talking to me.”
  • “I had a good day today – I’m going to feel terrible tomorrow.”

Black and white thinking

People often see things as black or white when they’re struggling with pain – there’s no ‘in between’.

For example:

  • “I can’t cuddle my child/grandchild – they think I don’t love them or that I’m a bad parent/grandparent.”

Must and should statements

People often have fixed rules for themselves about what they “should” do and how they “should” feel, and judge themselves harshly if they don’t meet these expectations.

For example:

  • “I must vacuum the whole house every day.”

When people think like this, they’re being critical of themselves, which brings their mood down.

If you find yourself thinking this way, it can help a lot to accept that things and people aren’t always perfect, and they don’t have to be for you to be happy.

Jumping to conclusions

People often assume they know what others are thinking, and the assumptions are usually negative.

For example:

  • “People at work think I’m taking advantage because I can’t do as much physical work as they can.”

Jumping to conclusions can also make you feel like you know the future, and that it will be bad.

For example:

  • “I lost my job – I’ll never find another one.”


Based on one isolated incident, people with this thinking pattern assume all future events will follow a similar pattern. It becomes hard to see a negative event as a one-off.

For example:

  • “I wasn’t able to pace this activity properly – I’ll never be able to get pacing right.”

Dismissing the positives

Often people can ignore the positive aspects of life or situations, and instead focus on the negative.

For example:

  • “I played a game with my granddaughter, but I feel awful because I couldn’t take her to the park.”


People who are feeling low often label themselves in negative ways.

For example:

  • “I’m a burden to my partner/family.”

Section 10 of 18

10. Challenges to an unhelpful thought

Now you can challenge your unhelpful thoughts by asking these questions. Work through the questions below, using the examples to give you ideas.


“I wasn’t able to do any cleaning today and the house is a mess. My partner is going to be annoyed with me. I’m a burden.”

1. Is there any evidence against this thought?

  • “I’m usually able to do some housework.”
  • “My partner never gets annoyed with me for not doing housework.”
  • “My partner tells me I’m not a burden – they don’t love me for my cleaning skills.”

2. Is there any evidence for this thought (based in fact)?

  • “The house is a little dusty.”
  • “Sometimes my partner is in a bad mood after work.”

3. Can you identify any patterns of unhelpful thinking?

  • “I’m labelling myself in a negative way by saying I’m a burden.”
  • “I’m jumping to conclusions by predicting how my partner’s going to feel.”
  • “I’m using must and should statements. I’m setting fixed rules for myself about how much housework I should do.”

4. What would you say to a friend who had this thought in a similar situation?

  • “I’d say they’re being unfair to themselves – I’d remind them that when you’ve been in pain all day, it’s understandable that you wouldn’t be able to clean everything.”

5. Is there another way of looking at this situation?

  • “This is a good opportunity to try pacing and spacing.”

6. Is there a proactive solution to this unhelpful thought?

  • “I’ll see if I can do some housework without making my pain flare up. Even if I can’t get much done, my partner will be proud of me for trying.”

Section 11 of 18

11. Goal setting

You may find you’ve had to give up going places or doing things that you used to enjoy because you’re afraid your pain will get worse. Or it might have become frightening for you to think about doing something new.

Setting goals for yourself is a bit like picking a direction on a compass – you’ll find yourself reaching points on the way that show how far you’ve come, and there isn’t necessarily a single place where you’ll stop.

graphic showing North on a compass with a line leading to it from the centre that has Goal 1, Goal 2, Goal 3, Goal 4, and Goal 5 marked at even intervals

Goal setting’s a bit like pacing – you use it to find the right activity level for yourself. It’s about getting some control back for yourself, and stopping the pain from taking over.

Here are four rules to follow to help goal setting work for you:

  • The goal should be something that matters to you.
  • It should be realistic – don’t pick something that’s really difficult.
  • Make sure you can measure the goal and identify when you’ve hit an important point towards achieving it – so instead of saying, “I want to be thin,” you could say, “I want to lose 5 kilograms.”
  • The goal shouldn’t be about making someone else happy – it should be something that benefits you and makes you feel good about yourself.

Section 12 of 18

12. Making an action plan - Activity 3

Once you’ve decided on your goal, think about all the things you need to do to achieve it. Use the boxes below to write out your action plan step by step. You can save and download this at the end of the guide. Alternatively, you can download a PDF action plan below to fill out on your device.

Download an action plan

The text you add to the PDF action plan will only be saved to your device.

Please note: if you use an iPhone, the only way to edit the action plan is by using a PDF app on your device.

For example, Emma wanted to have a 30-minute walk around the park near her house 3 times a week. She decided to use pacing techniques to make sure her pain didn’t flare up.

Action plan

It’s important to review your progress regularly – about once a week if you can. If any of your methods aren’t working, think about different ways to achieve your goal.

Each small step is an achievement in itself – lots of small steps can help you take one big leap.

Remember to always take the time to enjoy your successes, and reward yourself when you achieve a goal.

Section 13 of 18

13. Managing stress and relaxing

Stress can make pain worse, so it’s important to learn how to manage it. At the same time, pain itself can make you feel stressed and anxious, creating a vicious cycle. Learning relaxation skills can help you to break this cycle, and manage both stress and pain in a way that works for you.

We have a number of other breathing and relaxation exercises on NHS inform that can help with anxiety and stress. Try doing one of these when you’re feeling anxious.

Breathing and relaxation exercises

Learn new ways of feeling calmer and more relaxed in day-to-day life.

10 stress busters

To learn other ways of managing stress, take a look at our other information on dealing with stress in day-to-day life.

Section 14 of 18

14. Assertiveness and communication

Chronic pain can cause you to lose your confidence, and make it hard for you to express your needs. If you can’t say what you need, you may find yourself dealing with more pain and discomfort, and feeling more tense – and tension can increase your pain.

Follow these tips to help you become more assertive and confident about communicating.

Say what you mean clearly and don't be afraid to be firm.

Don’t say:

“I’m really sorry but I think I need to stop, maybe sit down for a minute, if that’s okay?”


“I need to take a break – I can’t walk any further just now.”

Don't shout or raise your voice.

Don’t say:

“I need to take a break right now!”


“I need to take a break now.”

Remember you don't have to apologise for needing something.

Don’t say:

“I’m really sorry but I think I need to sit down for a minute.”


“I think I need to sit down for a minute.”

Make sure your message is clear – don't expect people to guess what you mean or know what you're thinking.

Don’t say:

“My back is a bit sore.”


“My back is getting sore, I need to rest for a few minutes.”

Explain to people why you're asking them to do something.

Don’t say:

“We need to stop.”


“I need to rest for a few minutes because my back is getting sore, so we need to stop.”

Ask for help when you need it.

Don’t say:



“Could you please carry this bag for me for a while? My back is starting to hurt.”

It’s okay to say no.

Don’t say:

“Yes, that’s fine, I think I can manage that.”


“No, I won’t be able to do that.”

Section 15 of 18

15. Sleep

Chronic pain can cause a lot of problems with sleep. You might find it hard to get to sleep, or wake up during the night because of pain. Unfortunately, the more you try to force yourself to sleep the harder it can become. Lack of sleep and struggling to sleep can also increase your stress levels, making the pain worse.

Look at our self-help guide for sleep problems and insomnia to help you deal with these issues.

Sleep problems and insomnia self-help guide

Work through a self-help guide that uses cognitive behavioural therapy (CBT) and expert advice to manage sleep problems.

Section 16 of 18

16. Exercise

Chronic pain can make it seem like exercise would be a bad idea – you might be afraid of making the pain worse. In fact, it can make you feel better to exercise and stay active as long as you stay within realistic limits.

Avoiding certain movements and activities can actually make pain worse, because your muscles and joints can become stiff. This is called the pain cycle.graphic showing a cycle in the middle, and outlining the pattern of pain leading to less movement, which leads to stiff joints and muscles, which leads to more pain, which leads to less movement, which leads to weight gain and weak muscles, which puts strain on joints, which leads back to pain

Muscles that you don’t use actually feel more pain than ones that are toned, flexible, and strong. Once you’ve found an exercise plan that works for you, it’ll be possible to be more active and feel better.

Learn more about managing muscle, bone and joint pain

Our section on musculoskeletal problems, injuries and conditions that affect muscles, bones and joints in adults has self-management advice, exercises, and information on services.

Section 17 of 18

17. Coping with flare-ups

You might sometimes experience periods of increased pain, often called flare-ups. The amount of time these flare-ups last is different for everyone. Flare-ups can happen quickly and without warning, so they can be difficult to cope with, but there are ways to make them easier.

When you have a flare-up it can be tempting to go back to the old habits discussed earlier in the guide, like avoiding activity or spending lots of time in bed. Try not to do this. It’s important to accept that flare-ups happen, they aren’t your fault, and it’s possible to cope with them. Dealing with flare-ups is a skill that you can develop and build on with time.

These tips will help you cope with flare-ups.

Sometimes flare-ups happen for no reason, but you may feel more in control if you can identify a cause. Did you do anything unusual before the flare-up happened? Have you been more active? Have you been feeling low or stressed? Thinking about potential causes can also help you plan how to avoid a flare-up in the future.

Prepare in advance. Keep a supply of any medication you use, and if there are items that help with your pain, like a heating pad for example, make sure they are available.

Don’t panic – tell yourself that it’s a flare-up, and it won’t last forever.

Unhelpful thoughts like the ones covered in this guide can be especially bad during a flare-up. Make sure you use the techniques in this guide to help you think more positively – feeling angry or low can make you feel worse.

Take your medications regularly – don’t try to ‘be brave’ and avoid taking painkillers when you need them.

If you can’t keep going with your exercises during the flare-up, start doing them again slowly when it’s passed. Feel free to rethink your exercise goals and change them if you need to.

Be kind to yourself – use the techniques from this guide to help you stay active in a balanced way.

Section 18 of 18

18. Next steps

Urgent help

This self-help guide is intended for people with mild-to-moderate mental health issues.

If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

For an emergency ambulance phone 999.

While CBT doesn’t promise to reduce the pain, using the techniques in this guide can make you feel more in control, and help make sure the pain has less impact on your quality of life.

Keep using the techniques you found helpful from this guide – they should continue to benefit you. If there are some things that you didn’t find helpful to begin with, stick with them for a few weeks – CBT can take a little time to work.

Further help

If you’re feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

If you feel you need more help with your mental health, try speaking to your GP, or search for mental health and wellbeing services in your area.

For information and adv/scotlands-serice when you’re feeling down, you can phone Breathing Space on 0800 83 85 87.

The Breathing Space phoneline is available:

  • 24 hours at weekends (6pm Friday to 6am Monday)
  • 6pm to 2am on weekdays (Monday to Thursday)

If you found this guide helpful and would like to do more work like this, Living Life offers a range of structured psychological interventions and therapies to improve mental health and wellbeing. This service is appointment-based and specifically for low mood, or mild/moderate depression or anxiety. Living Life are open Monday to Friday, from 1pm to 9pm, and you can phone them on 0800 328 9655 for an assessment appointment.

Learn more

To learn more about coping with anxiety and stress around pain, you can visit some other parts of NHS inform:

Complete a self-help guide for anxiety

Learn more about anxiety and your mental wellbeing

Learn about panic attacks

Read about dealing with panic attacks

Find out about stress

Read our 10 stress busters

Try some breathing and relaxation exercises

Other websites to visit

For more information on coping with pain, you can visit Pain Concern.

For information about pain management and more self-help advice, you can visit Pain Management.

Last updated:
27 May 2021