iCBT Program for Chronic Pain

Module 8. Healthy Eating

It is very important for people with chronic pain to maintain healthy eating patterns.

More often than not, a negative cycle occurs when the pain sufferer lacks energy to prepare a nutritious meal, often causing them more fatigue.

Poor nutrition leads to physical exhaustion. Someone suffering from chronic pain is already exhausted, the last thing they need is to have another source of exhaustion.

Eating poorly, or not enough, can have significant consequences, leading to a loss of energy, fatigue, stiffness, reduction in activity, and feelings of discouragement.


Any of these can increase the severity of pain.

negative food cycle

Healthy Eating Recommendations

  1. Eat fresh fruits and vegetables
  2. Eat fish – it will provide you with energy
  3. Eat red meat – eat it once or twice a month
  4. Eat legumes – they are “superfoods”
  5. Eat nuts – they are a good source of energy (choose unsalted!)
  6. Eat eggs in moderation – they are a good source of protein
  7. Avoid added sugars in foods. Even “natural” sugars (maple syrup, honey, etc.) should be avoided in large quantities
  8. Avoid trans and saturated fats – they clog arteries
  9. Always read the nutrition labels
  10. Avoid preservatives - eat more natural foods

Importance of Sleep

Sleep is the body’s way of recuperation. If you cannot sleep well, your body cannot relax and replenish its energy. Poor sleep can cause increases in pain levels.

Individuals with chronic pain face a vicious sleep cycle that can damage the body's ability to recover from the pain.

chronic pain cycle
Here are some things you can do to help with your night's sleep:

  • No lights on in the room. This includes electronic devices, blinking lights, TV playing, etc.
  • Drink warm milk or herbal tea 1 hour before bed.
  • Stretch prior to bed, focusing especially on your chronic pain areas.
  • Do your exercises in the mornings instead of afternoons or evenings.
  • Have a warm bath or hot shower before bed to help relax your muscles.
  • Minimize your caffeine intake, avoid caffeine after 2 pm.
  • Avoid napping during the day, or limit your nap to one 20 minute session.
  • Go to bed, and wake up, at the same time daily. Including weekends.
  • Try meditation before bed.


The less exercise you do, the more your pain will worsen over time.

Below you will have access to exercises to help with specific areas of pain, as well as be shown how to exercise and do activities safely with chronic pain.


Pacing is finding the exact amount of activity you can do without causing a flare-up of pain symptoms.

Once you discover this amount, you can work at this level to increase strength and ability over time.

To use the pacing technique, go by the following chart. Write down the distance or time you are able to do an activity for on a “good” pain day and again on a “bad” pain day.

The distance or time that you should be doing the activity daily will be between these two values. A good time is, at most, 5 minutes less than your time on a “good” pain day. If you feel like the time you’ve selected is too easy, slowly increase it! Remember, the time you selected is not permanent and can be adjusted according to your pain levels and feelings for each day. You can do this for walking, gardening, cleaning, or even when starting the exercises in the next section.

Below is an example of how your chart should look.

activity chart example

Specific Exercises for Chronic Pain

Use the links below and find the page on our website that matches your area(s) of pain. There, you will find exercises with pictures and descriptions of how to complete them properly.

Use this as a guide and try the exercises daily for the best results. Using the pain diary you completed in Week 2, find the times of day when your pain is at its lowest and schedule your exercises for that time of the day!

Homework for Module 8

Click here to download the Food Intake Journal.
Journal your food intake for 7 days.

Click here to download the Sleep Journal.
Journal your sleep schedule for 7 days.

Click here to download the Exercise Journal.
Journal your exercise for 7 days.

Importance of Documentation

If you want to maintain good habits and positive changes, you must continue documenting your progress.

For decreases in anxiety, depression, and pain levels, you must maintain these habits. Use all of the tables provided in your homework to document your progress in all domains of each module in this program.

Remember to:
  1. Set SMART goals
  2. Keep a pain diary
  3. Keep a daily mood log
  4. Document thoughts that trigger strong feelings in you
  5. Practice positive self-talk, note down positive affirmations daily
  6. Keep a relaxation diary
  7. Keep a meditation diary
  8. Track your sleep patterns
  9. Track your eating patterns
  10. Track your exercise patterns

You have now obtained the tools and the knowledge needed to gain control of your anxiety, depression, and negative thoughts.

Remember to follow the steps on the previous page to maintain what you have learned until it becomes habitual.

If you follow all the steps, and use the tools provided, you will not only see your negative thoughts decrease, but your pain levels as well.

CONGRATULATIONS on completing the iCBT program for chronic pain!

Best of luck in your continued journey.
You CAN and WILL get better.
Never give up.

Exercises for Different Areas of Pain from Wilderman Medical Clinic

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