Self-management action plan
Create a plan to manage your pain
Download the Self-Management Action Plan PDF. Use this form to hand write your responses.
You may use one plan for each strategy on the wheel.
Steps for your reference
- One way I want to better manage my health is (examples: walk, stretch, do a relaxation exercise, take medications as prescribed): ____________________
- I will focus on this for the next _______ (# days, weeks).
- When I will do it (examples: every day after work, Mon/Wed/Fri mornings): ____________________
- Where I will do it (examples: at the gym, in my neighborhood, at physical therapy): ____________________
- What might get in the way of following through (examples: I may have other things to do, it might rain): ____________________
- What I will do about it (examples: pick another day, go to the gym, get rain gear): ____________________
If I rated my chance for success less than 80% on the chart below, what improvements can I make to my plan to increase my rating? ________________________________________________________________________________________
