Chronic pain therapy worksheet

What is the theory behind this Chronic pain therapy worksheet?

Pain is an unpredictable part of our lives. While for some it can be temporary for others it becomes a lasting condition that significantly impacts their quality of life. The biopsychosocial model explains the experience of pain as multidimensional including not just the physical aspect but psychological, social and behavioral as well. 

How will the worksheet help?

One of the ways for chronic pain management is to focus on short-term or long-term attainable goals. The worksheet will help you establish a SMART short-term goal for pain management. It will facilitate in breaking down each goal, so clients can achieve them in a systematic manner.

How to use the worksheet?

Help the client Identify a monthly achievable goal for pain management, make it S.M.A.R.T with the help of the table given in Part A and track it daily by using the Daily record table in Part B. Discuss the enablers and barriers with the clients in each therapy session.

Chronic pain therapy worksheet

Part A

Instructions: Make a SMART goal for a maximum time of one month.

Your goalE.g. Taking prescribed medicines after breakfast and dinner daily for one month.

Is your goal SMART?
SPECIFIC(Can you be specific about the event or situation?)Taking medicine after breakfast and dinner.
MEASURABLE(Can you measure/count this goal?)By putting the medicines in the labelled box from Monday-Sunday.
ATTAINABLE(Do you have the resources to complete this goal? Is it easily achievable?)By completing the daily track log.

RELEVANT(How is the goal meaningful to you?For pain management and improved quality of life.
TIMELY(How much time will you take to complete the goal?)
One month.

Part B

Daily record table

Mark the table after you have completed whatever you need to do to get closer to your goal

Week 1Week 2Week 3Week 4


Doran, G.T. (1981). There’s a S.M.A.R.T. way to write management’s goals and objectives. Management Review, 70(11), 35-36.

Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581-624

Murphy, J.L., McKellar, J.D., Raffa, S.D., Clark, M.E., Kerns, R.D., & Karlin, B.E. (n.d).Cognitive behavioral therapy for chronic pain among veterans: Therapist manual. Washington, DC: U.S. Department of Veterans Affairs.

You can download this worksheet here.

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