On a good day you catch up on everything that has piled up: the windows, a big supermarket run, an hour in the garden after lunch. By evening your back is complaining, and you spend most of the next two days on the sofa. Once it eases, the cycle starts again. Pacing chronic pain means breaking that loop. You plan activity by the clock and stop letting the pain of the moment decide how much you do.
Physiotherapists and occupational therapists teach pacing as a core skill, and pain management programmes include it. To get started you need two things: honest records from two weeks and a starting level you can manage on a bad day too. A pain diary gives you both.
The boom-and-bust cycle
Pain specialists call the loop boom and bust, sometimes the overactivity-underactivity cycle. In the boom phase you make the most of a good day and do far more than your body is used to. In the bust phase you pay for it with a flare-up and several days of rest.
Over months the balance tips. The rest phases cost you fitness, the next boom ends sooner, and your average activity drops even though you push hard on good days. You rarely notice this from inside a single week. Put the weeks side by side and the pattern shows.
Two signs give boom and bust away in a diary:
- A zigzag line. High scores follow days with a lot of activity, often with a gap of one day.
- Delayed peaks. The pain climbs hours after the effort or the next morning. On the boom day itself you feel fine, which is why you underestimate it without written records.
Two weeks of records as your foundation
Your baseline is the amount of an activity you can manage on good and bad days alike without a flare the day after. You find it in your own data. For two weeks you change nothing about your routine and write down:
- Your pain score morning and evening on the same scale. The article on the 0 to 10 pain scale explains how to keep your numbers comparable.
- The demanding activities and how long they lasted: walking, standing, housework, screen work.
- The point where the pain rose noticeably, in minutes. For example: "Standing at the stove, clearly worse after 25 min."
- Your score the next morning. It captures the delayed reaction you can't feel yet in the evening.
Start with the two or three activities that matter most in your day. Ten activities at once won't survive two weeks.
From average to starting level
Say you recorded on ten days how long you could walk before the pain went up: 20, 35, 15, 30, 25, 40, 20, 15, 30 and 20 minutes. That adds up to 250 minutes, an average of 25.
You set your starting level below that average so you can reach it on a bad day. In this example, 20 minutes would be a sensible start. The 40 minutes from your best day make a poor yardstick, because two weaker days followed it.
Your plan grows out of that number:
- Time over feeling: You walk for 20 minutes, good day or not, and stop before the pain climbs.
- Split the task: You break larger jobs into chunks with breaks in between. "Clean all the windows" turns into two rooms in the morning and two in the afternoon.
- Build up slowly: If the starting level holds for a week without a flare, you add a little, two minutes in the example. If a flare comes, you drop back to the last level that held.
One exception: with ME/CFS and post-exertional malaise, different rules apply, and gradual increases are not the focus. In that case, agree the approach with your doctor or therapist.
How PainTrack fits into pacing
The free version covers pacing. You create one pain definition and log a score morning and evening. Behind "+ Add tags" you'll find the circumstances, including "was moving around", "stood for a long time", "was resting" and "was working". You add your own tags, such as "kept to plan" or "overdid it", under "More" → "Tags". Durations go in the note, written the same way each time: "Walk 20 min, pain up after 18".
On the Analysis page, History shows you the zigzag, with the 7 and 30 day ranges free. Weekly trend compares your average over the last seven days with the previous week and with the week four weeks ago. Pro adds the comparison with three months ago, the 90 day and "All" ranges, and the trigger analysis. It works out whether your intensity runs higher on entries with a tag like "stood for a long time" than on entries without it. The result shows a correlation, not a cause.
Signs that pacing is working
Don't expect much lower pain scores in the first weeks. Pacing aims for stability first, and you can read that in three places:
- The line flattens out and upward spikes come less often.
- The number of flare days per month goes down. Set your own threshold for this, for example any day scoring 7 or more.
- Your starting level grows over the weeks, and you can hold it.
Log the good days as well. Without them you have nothing to compare against and no evidence that building up works. The basic setup of a diary is covered in how to keep a pain diary. In case a flare-up comes anyway, write yourself a plan for bad days in advance. To check which circumstances line up with higher scores for you, use the method in finding your pain triggers.
Frequently asked questions
What is pacing for chronic pain? Pacing means planning activity by time and plan instead of by the pain you feel in the moment. You work from a starting level below your usual limit, take breaks before the pain rises and build up in small steps.
How do I find my pacing baseline? For two weeks, record how long you do your main activities and how your pain responds, without changing anything. Take the average and set your starting level a little below it.
Should I do more on good days? Stick to the plan on good days as well. The extra effort on a good day is the boom that leads to the bust.
How long does pacing take to help? There is no fixed timeframe. Allow several weeks, judge the trend over months and go through it with your physiotherapist or doctor.
PainTrack is not a medical device and does not replace medical diagnosis or treatment. The app is intended for personal documentation and self-observation.