Managing Chronic Pain Between Appointments: What Actually Helps

It didn't take me long at the beginning of my career to recognise that most of what influences persistent pain is not happening in my appointments, it often happened outside of them. A good session with a physio, doctor or therapist might be 1-2 hours of your week. And don't get me wrong, as I have become more experienced, I'm definitely becoming more effective in that hour or two I spend with someone but what about the other 167 hours in the week?

I've worked with people in pain for 16 years, and I've seen firsthand how the uncontrollable thing we call life throws hook after hook and jab after jab that make making progress challenging at times. You might have a really good appointment. You feel a bit looser, lighter & more hopeful. Then you go home, life does what life does, and by the time your next appointment rolls around, you feel like you're more or less back where you started because you haven't managed to do enough of your exercises and you've had a lot of other demands pulling on your attention.

That's not because the appointment was useless, or because your physio/therapist did something wrong. It's because if a good appointment helped to add a few "safety" blocks for your nervous system, the rest of the week potentially added just as many (if not more) "threat" blocks: a poorer night's sleep, a major stressor entering the group chat of life, an unexpected financial or personal circumstance that demands all of your resources to navigate.

Treatment often helps but it's only one hour in your week or maybe one hour in your month. What you do in your own time outside of appointments matters FAR more for long-term progress.

Most clients have told me that in the past they'd leave an appointment with a few pieces:

• some exercises, maybe on a sheet or in an app (if your therapist was techy)
• some advice, which may or may not match what the last person said
• a vague sense of "do a bit more, but not too much"

What they don't leave with is clear guidance and a way to connect those pieces day to day.

Which exercise today, when it hurts more than usual? How much is too much? Is this flare up truly something that's going to set me back or just a bad day? Should I rest, or push forward?

So they end up making their best guess. Some do too much on good days and pay for it (boom and bust). Some do almost nothing in case it makes things worse (fear avoidance).¹ Both are completely understandable and not the person's fault. The long-term net effect is that both options tend to lead to much less overall change in their pain.

1. Understand what's going on

This is usually the best place to start. I've consistently found that people who understand what their pain does and doesn't mean often do much better than someone who's unclear. That sounds really logical and straightforward but it's rare to find a person coming in who really does have that piece nailed down.

Helping a person to understand that pain doesn't always equal damage, and that sensitivity, stress, sleep and beliefs all play a part, often helps them find movement less frightening, and research suggests pairing pain education with movement can help more than either alone.² If you'd like a bit more on this, read Chronic pain but a normal MRI or scan.

2. Little and often beats big and rare

Short bouts of gentle movement most days do more than one or two big sessions in a week. Five or ten minutes counts. Walking counts. The goal is to give your nervous system regular, safe, manageable experiences of movement. It's one thing to cognitively understand something (and as written above this understanding is very important) and it's another thing to fully embody this cognitive understanding with experiential evidence in the form of movement. Put another way - building regular experiences that demonstrate evidence of safety for your brain about your body is one of the most potent tools to create change in a human nervous system.

3. Pace, don't push or avoid

Pacing is a huge tool in the tool belt. When you're having good days, do what feels manageable and resist the temptation to push on and do more than you had planned. On harder days when you are ticking the box and building consistency, do what you know you can do safely. If you aren't sure what that might be - this YouTube video is a short little rule of thumb that many clients have found useful for this. Don't treat it as an absolute - it's just some simple guidance that might help you.

Play: Pacing, the rule of twos and threesPlays from YouTube

4. Have a flare plan before you need it

Flare-ups are much less problematic and frustrating when you've got a plan in place for how you are going to manage it. Think of these as principles that can apply to most of these types of situations: What you might want to reduce to avoid further issues, what gentle movements to keep doing to continue demonstrating evidence of safety despite a flare up, what helps you calm down and regulate your nervous system, and lastly, when to go get yourself checked out by a healthcare professional if you need to. Making decisions in the middle of a flare up isn't an easy option so a plan can really help. More here: Why does chronic pain flare when life gets stressful?

5. Look after sleep and stress

Poor sleep and high stress can both negatively influence pain. You don't need a perfect routine here either. Regular sleep times and a few minutes a day of something that calms you, some dedicated breathwork, a walk, natural light exposure, listening to some music, or reading a book are all good places to start. Whatever works for you.

6. Watch the trend, not the day

Keep a simple note of pain, sleep, mood and what you did. Bad days will still come, but over weeks you'll see what's actually changing, and what tends to come before a harder day. The trend is more important than the event. If you struggle with the tracking piece, use the notes app on your phone and dump in a voice note at the end of a day or you can move to something more structured like what we have built inside Bigger Than Pain.

7. Keep your clinician in the loop

Bring what you've noticed to your next appointment. "My pain symptoms definitely seem to be influenced by the quality of sleep I have more so than the exercises, they are fine" - is far more useful than "it's been up and down". Your therapist can then know that exercises are possible, not triggering any increase in symptoms and you might be ready for some progression to more challenging exercises. (I'm all for any measure of progress we can demonstrate when it comes to helping someone with chronic pain!) As mentioned above if anything new, worsening or worrying shows up between appointments, get it checked out rather than waiting.

None of the above is complicated on its own. The hard part is doing it together, consistently, while life gets in the way, and knowing which piece matters most today.

That's the gap Bigger Than Pain has been built for. One platform that brings pain education, nervous system regulation, guided movement, flare support and tracking into a daily plan, so that you have structure rather than guesswork. It works alongside your physio, GP or clinic, not instead of them. Or if you are currently unable to find someone to work with or are between health care professionals, it is designed to support you then too. Everything is personalised inside BTP from your onboarding to your in-app content to the guided movement self-check and movement plans and the support built around all of that. We adapt to support you in the moment and over the longer term if you need that.

If you're not sure where you're starting from, the free Clarity Report is a short conversation that reflects what may be driving your pain and where to begin.

This article is general education, not a diagnosis or a substitute for care from your GP or healthcare team. If your pain is new, getting worse, or comes with symptoms that worry you, please get it checked.

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