CBT for Pain - Module 9 Summary

CBT for Pain: Prevent Relapse

Life is full of stressful moments.

These moments may bring pain, or worsen the pain you already have. You may find it harder to prevent or control your pain - in other words, you may experience a relapse. In this module, we’ll cover some situations that may lead to a relapse. We’ll also review some ways to cope if you experience one.

Throughout this entire course of CBT for pain, you’ve learned about the connection between chronic stress and pain. Your negative mood affects how you view pain, which in turn affects the way you cope with your pain.

At this point, you may have learned how to prevent your flare-ups. Your pain might be much better. But, you may still experience a relapse. By preparing for a relapse, you’ll be more able to cope with negative thoughts and feelings that could lead to poor pain control behaviors.

High-Risk Situations

There are some stressful situations that can increase your risk of relapse.

  • Problems with work

  • Financial difficulties

  • Family/relationship challenges

  • Short- or long-term illness

  • Trouble sleeping

  • Loss or grief

  • Change in environment, like moving or travel

If any of these apply to you, talk with your coach to identify ways of coping with them.

Relapse Cycle

A relapse cycle starts when you experience a stressful situation - a trigger. This could be a minor source of stress at work, or a serious family event. No matter the size of the issue, you may feel anxious.

Due to the negative thoughts and emotions triggered by stress, you start having trouble controlling your pain. You might adopt behaviors that make it hard to manage your pain. All of this combined leads to worsened pain. The unhealthy cycle continues with more unhelpful thoughts and behaviors, and the pattern moves forward until you’re back where you started.

The diagram below shows a typical relapse cycle.

Coping With Flare-Ups

Flare-ups, or pain that’s worse than normal, are common for those who have pain. Planning ahead makes it easier to manage your pain before it becomes unbearable. From previous modules, you’ve learned that coping strategies are skills that can help you manage pain.

Before using coping strategies:

Identify your flare-up triggers, and be specific. Doing so helps you plan for those specific situations and events. For example, instead of noting just “stress” as a trigger, you might say “getting the kids ready for school in the morning." You can use your journal to make note of your triggers.

The next few slides will review the pain management and coping strategies you learned about in the last few modules.

Coping Strategies

Pain, Stress, Thoughts, & Feelings

  • Keep a pain log to learn more about your pain patterns and what contributes to your pain

  • Identify and monitor your thoughts and feelings that happen before or with your pain

  • Use positive affirmations


  • Plan some enjoyable physical activities, adding or increasing them as you get stronger

  • Know your barriers to engaging in activity

  • Make sure you pace yourself - balance movement with rest


  • Make necessary changes to your bedtime routine, daytime habits, and activities to help improve sleep

Last - 

  • Seek support from your coach, a mental health therapist, or family members and friends

  • Be patient - change takes time

You can also use your journal to keep track of stressful moments, and notice any patterns with your habits and pain. Bringing awareness to them may help you catch a relapse before it becomes worse.

Progress Check

The next section will review how much you’ve learned about your pain through a handful of questions.

Think back to before you started this course of CBT for pain. On a scale from 0 to 10 (0 = not at all; 10 = as much as possible), where would you rate your ability to control your pain?

Using that same scale, how would you rate your ability to control your pain now?

Think about all the ways your pain has limited you in the past. Where do you feel you made the most progress?

When it comes to managing your pain, what has changed for you since the start of this program?

What coping method or pain management strategy has worked best for you?

How has your mood changed?

Even though you may still have pain, how has your life changed?

In what ways has your ability to complete day-to-day tasks changed?

How has the intensity of your pain changed?

How has your reaction to pain changed?


  • Relapses may happen, and they can make it harder to prevent or control your pain

  • Triggers are stressful situations, thoughts, or feelings that may lead to pain flare-ups

  • Becoming aware of your pain triggers can help prevent a relapse

  • Flare-ups are normal if you have chronic pain

  • You can use coping strategies to help manage your pain through a flare-up or relapse

Congratulations on making it all the way to the end of CBT for Pain! We hope you learned new ways to manage your pain, and are on your way to improving. Please share any feedback you may have with your coach.