A flare or flare up is a period of temporary intense pain, which is more severe than your usual chronic pain. Flares may last hours or days, with no identifiable pattern and very little warning. Flares can be described as spasms, electricity, cramps, sharp or jabbing sensations, to name a few.
Despite an effective pain management plan, flares in pain may still occur. The first step to managing a flare in pain is to identify is this breakthrough pain, flare pain or a new pain?
- Breakthrough pain: is generally when medications start to be less effective and pain breaks through. It is important to see your doctor to discuss this if it occurs.
- Flare pain: is generally your usual pain, in the same location, but greater in intensity.
- New pain: this could be a new pain, in a new location, or a new symptom like muscle weakness or numbness, nausea or vomiting, or a temperature. It is important that you see your doctor if this occurs.
In this article we will be focusing on flare pain and:
- Prevention: How to reduce the frequency and severity of these episodes
- Management: How to manage flares when they do occur
- Learning: How to learn from flares to assist you in the future
Prevention – Before a Flare
- Stay healthy by eating a well-balanced diet, drinking plenty of water, minimising alcohol and cigarette use. Not only do all of these things have an impact on pain levels and sensitivity, but they increase your mental, emotional and physical wellbeing.
- Keep Active. Exercise is still considered one of the best treatments for reducing pain severity, increasing functional capacity and improving quality of life. Regular exercise helps reduce episodes of central sensitisation when paced appropriately. To learn more visit here.
- Identify if there is a trigger. Triggers come in many shapes and sizes and can include:
- Changes to activity levels
- Increased stress levels
- Changes to the weather
- Changes to sleep quantity or quality
- Family or relationship challenges
- Work or financial challenges
- Changes to mood
- Extended periods in one position or doing one activity
- Recent illnesses e.g. a cold or flu
- Changes in hormones
- Identify if there is a pattern. Patterns to flares help you to identify if certain moods, activities or weather patterns correlate with increased pain levels. Although these may not be able to be avoided, they may help you to prepare and simplify your day or week.
- Use pacing strategies, graded activity and graded exposure. Prevention is always better than cure. By working to a plan and not your limits, you can avoid boom and bust patterns and pain flares. To learn more about this visit here.
- Tackle your unhelpful repetitive thoughts. Learning strategies for reframing thoughts when your pain is settled, helps you manage them better during a flare. To learn more about the benefits of reframing thoughts visit here.
- Manage your stress levels. Stress and chronic pain are often considered two sides of the same coin. When one is bad, it feeds into the other. Learning to manage your stress levels may assist with minimising flares in pain. To learn more about stress and pain visit here.
- Learn the phrase “hurt versus harm”. Pain is a very unpleasant sensation which causes a lot of “hurt”. A vast majority of the time, chronic pain and flares in pain are “hurt”. Whereas “harm” is often what is associated with: new pain, an injury, illness or acute pain. Knowing that a flare is hurt, often helps to deescalate the cascade of worries and fears associated with it. To learn more about the concept of “hurt versus harm” visit here.
- Manage your pain – be realistic. Remember, eliminating your pain entirely may not be realistic. Managing pain, is working out a pathway forward with improved function, quality of life and less pain. These goals are part of the premise behind active self-management. To learn more visit here.
- Learn the art of mindfulness and relaxation. There is evolving research about the roles of mindfulness and relaxation in calming your nervous system, observing and de-identifying from pain and reducing the mental and emotional toll of pain.
- Shift your expectations of life and yourself. Learning a way of accepting the “new normal” of life with pain is incredibly challenging, but often: fighting against the pain by pushing through pain, soldiering on, ignoring pain; or even just getting on with things like you always have, leads to boom and bust cycles and more frequent flares in pain. The “Coping with pain series” written by the Institute for Chronic Pain discusses how people with chronic pain cope well.
Management – During a Flare
- Recognise what is happening and how you are feeling. Often allowing yourself to feel how you feel – without judgement or guilt – breaks the cycle. To learn more about this visit here.
- Take the medications prescribed by your doctor, but avoid escalating doses for prolonged periods of time. Using your breakthrough medication, as prescribed by your doctor can be helpful for reducing pain in the short term, but implementing active self-management strategies should be considered to avoid the long term need for escalating medication doses.
- Focus on things you can control. Often concentrating on the pain itself can become a hopeless battle. Whereas concentrating on the things right here and now that you can control, can provide a level of peace and confidence over the situation. The things you can control include your thoughts and actions in this moment. To learn more about this visit here.
- Reframe repetitive unhelpful thoughts. Unhelpful thoughts can often worsen the suffering associated with chronic pain and can be like adding fuel to an already burning fire. Working on strategies to deescalate the thoughts by re-framing or challenging them, can help to reduce the emotional toll they take on you. Visit here to download 5 worksheets for challenging unhelpful thoughts.
- Practice kindness and self-compassion. Learning to treat ourselves as we would a friend or loved one is vital in challenging times. Showing compassion and kindness towards ourselves allows us to find ways to look after ourselves during these times. Some strategies include watching your favourite movie, listening to relaxing music, reading a magazine, sitting in the sunshine and drinking a cup of tea, writing down how you are feeling or talking to a friend, or taking a bubble bath. The important thing is not to choose options that are “short term gain, but long-term pain”, like over-indulging in treat foods or alcohol. To learn more about this visit here.
- Find ways to distract yourself. Whilst being present with the pain through mindfulness can help some people, other people find distracting themselves more effective. Distracting yourself, particularly with hobbies and things that require concentration (like driving, colouring in, a jigsaw or building something with your hands) can allow you to distance yourself from your pain. To learn more about this visit here.
- Find ways of relaxing. As mentioned above, there is evolving research about the roles of relaxation in calming your nervous system, observing and de-identifying from pain and improving wellbeing.
- Express and vent your thoughts and emotions. There is a great deal of research on how expressive writing can help you to deal with challenging experiences and emotions. As the saying goes, a problem shared is a problem halved, and sometimes really expressing how you are feeling, releases the emotions from you, to allow you to heal. To learn more about this visit here.
- Manage sadness and isolation. Often with a flare in pain, comes a period of reduced activity and isolation, sadness and suffering. These are all very real and challenging. Speaking with your doctor, psychologist or psychiatrist, can help you to navigate these emotions and set up a plan for coping. Using digital platforms for connecting through these times can also be helpful. Some platforms you can access from home include:
- Beyond Blue: online forums, access this here
- SANE: online forums, access this here
- Black Dog: phone support, access this here
- Embrace, Multicultural Mental Health Support, access this here
- Headspace: community spaces, access this here
- Mens Line Australia: online counselling or phone support, access this here
- QLife: free LGBTI peer support, access this here
- Keeping moving – even if modified. When you are in enormous pain, every fiber of your body tells you to rest and recover. But when it comes to chronic pain, this can often only prolong and worsen the pain cycle. Using pacing techniques or modifying activities can help you to keep to your plan for movement. The general rule for flare management:
- <12hrs maintain activity
- 24-48hrs modify activity
- 48hrs drop your activity by 50-75%. But, try to keep moving despite pain.
- This too shall pass. Sometimes looking back at all life has thrown at you and all you have overcome, helps you to realise your strength and resilience. It can also help you to see how everything in life passes eventually. One technique used by practitioners is to imagine your body as the sky and your pain as the clouds floating by. Give your clouds different colours and characteristics, depending on the intensity of the pain. The dark grey storm clouds are your flares. The white fluffy clouds are your good days. Remember, the sky is always changing and the storm clouds pass.
Learning – After a Flare
- Recognise your strength and resilience. People living with pain are some of the strongest people who walk among us. Each day they move through life with the shadow of pain beside them. Recognising the strength, perseverance and resilience it takes to manage pain, is important for understanding why you feel emotionally, physically and mentally exhausted by it. After a flare has passed, be kind to yourself and take a moment to just be and feel the ease in pain. Learn more about self-compassion here
- Learn what worked and what didn’t during the episode. As Albert Einstein said, the definition of insanity is doing the same thing over and over and expecting different results. During and after a flare in pain: take the time to write down what worked well to alleviate pain or provide comfort, and what didn’t. These can be tools you use in the future.
- Take a look back at the days or hours before your flare. Learning what might have triggered your pain, can help you to modify or avoid the trigger.
- Learn the markers for the start of a flare – learn when to slow down to stop the progression. This can help to take the wind out of the sail of a flare, and stop it reaching the same crescendo. These steps may change the duration or intensity of the flare and get you back to “normal” sooner.
- Create a flare box. This is your toolkit for when a flare hits. It can include:
- A checklist of things to try to help with your flare
- Your favourite book, movie or CD
- Activities to help distract you, like a colouring book, rubrics cube, puzzle or lego
- A heat pack – often used for increasing blood flow, relaxing muscles, for pain localised in joints
- A cold pack – often used for reducing blood flow, reducing swelling, disrupting pain signals
- Photographs and cards from friends and loved ones
- Inspiring quotes and pictures
- Essential oils
- Relaxation and mindfulness activities, learn more here
- Create flare management plan. Being prepared, using what you know and what you are continually learning about your body and pain, and putting it into easy to follow steps, will help you prevent and manage flares in pain. To download the ACI’s Flare Management Plan, visit here
- Speak with your healthcare team to help you manage your flares. Remember, you are not in this on your own. Sometimes it is hard to see the forest for the tree’s and an external, objective opinion can guide you in the right direction: especially one that has been trained in chronic pain management.
- Use technology to help you prevent, manage and learn about flares. As most of us a using technology more and more, why not harness this power for your pain? There are some great apps for your phone that can track activity, weather, medications, mood etc. and pull these together to look for patterns or triggers for pain. They can also be sent as spreadsheets to your healthcare team, helping you to work through the challenge of flares together. To learn more about different apps you can use visit here.
If you are wanting to learn more about flare management and chronic pain, this section includes:
- Flare Management Resources
- Free Worksheets
Flare Management Resources
- Article: NPC: Flare Management (link)
- Article: PPM: How to deal with flares (link)
- Article: Healthtalk: Coping with Chronic Pain Flare Up’s (link)
- Article: IPSI: 7 ways to calm a flare and stop pain (link)
- Booklet: A Pain Flare Management Plan: Suggestions to Offer Patients Clinical Tool (link)
- Booklet: NHS: Managing Flare-Ups of Chronic Pain (link)
- Article: WebMD: Understanding Breakthrough Pain and Flares (link)
- Booklet: NHS: Chronic pain self-management Managing a flare up of pain (link)
- Factsheet: UWHealth: Coping with Chronic Pain (link)
- Article: Pathways: How to Avoid Chronic Pain Flare-ups and a ER Visit (link)
- Article: Action on Pain: Plan for Flare Ups (link)
- Factsheet: NHS: Coping with pain at its worst (link)
- Booklet: APMA: Living with Pain: The Emergency Department (link)
- Worksheet: ACI: Flare up plan (link)