Activity

Chronic pain: Quality prescribing - A guide for improvement 2026-2029
Scottish Government Effective Prescribing & Therapeutics Division

Chronic pain can have a significant impact on activity levels as individuals may consider ongoing pain to be an indication of further injury or damage.

Relationship between pain and activity management

  • Chronic pain can make some people fearful of “exercise” as they associate this with pain. The terms “movement” and “physical activity” are more supportive
  • Recognising unhelpful activity patterns such as ‘Boom and Bust’ (over and under activity) is a useful step in enabling individuals to adopt a more consistent approach to activity

 

Overactivity cycle

Figure 5

 

Underactivity cycle

Figure 6

 Potential strategies: 

  • Tailor management approaches to the individual’s activity patterns, e.g. behavioural activation if underactive, pacing if overactive
  • Physical activity is a recommended treatment for people living with chronic pain37.  The benefits of exercise are summarized in the figure below
  • Based on the individual’s needs, preferences and capabilities discuss possible activity interventions and choices regarding suitable activities38
  • Activity management interventions delivered by psychologically-informed clinicians and underpinned by a values-based approach and pain science education may encourage greater activity engagement, improving person-centred outcomes
  • The following approaches should be used to improve adherence to activity and exercise interventions:17
    • supervised exercise sessions
    • individualised exercises in group sessions
    • addition of supplementary material
    • provision of a combined group and home exercise programme
  • Reassure the individual that pain can be thought of as a protective system rather than an indicator of damage
  • Establishing barriers to activity or movement is important and addressing these will lead to improved outcomes
  • Acknowledge it can take practice to regulate activity and find a balance between over and under activity
    • Prioritise activity - prioritise what activities matter most
    • Plan activity - plan what do and when. Consider the activity and what is required. Break up activity into manageable steps
    • Proceed with activity - carry out the plan and be prepared to adapt it
    • Acknowledge you might not be able to complete it as initially planned and have different options to fall back on
  • Pacing can gradually help someone manage daily activities in a way that’s right for them, while reducing the risk of flare ups. Pacing can help because it allows someone to do things within their limits. This can help re-train the nervous system to be less protective

 

The benefits of exercise

Figure 7

 

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