How to Cope with Chronic Pain Flares

Unfortunately, chronic pain flares are a part of chronic pain and can be challenging to deal with. There are ways to better cope with pain flares and prepare for them. There are actions you can take to reduce your pain flares and the intensity of them.

What is Chronic Pain?

Chronic pain is often defined as pain that lasts for six months or longer. It usually doesn’t respond to the standard treatment modalities. It ultimately begins to affect your ability to engage in daily life activities.

What are Chronic Pain Flares?

Flare-ups are a normal part of chronic pain. A chronic pain flare is a period when the pain increases and can become more challenging to cope with. They may last for hours or days. They don’t always have a pattern or a warning.

You may feel able to cope with their day-to-day activities if the pain stays the same. During a flare, it might feel like the pain is overwhelming. You may feel a sense of helplessness. There isn’t always an apparent cause of a pain flare, although there is often a trigger or combination of triggers.

Flares can still occur despite an effective pain management plan. The first step to managing a flare in pain is to ensure it isn’t breakthrough or new pain. Those types of pain are essential to see your doctor about. Breakthrough pain is when medications become less effective and pain breaks through. New pain occurs in a new location, a change in pain description, or a new symptom with the pain (nausea, muscle weakness, temperature, etc.). A pain flare is your usual pain in the same location but greater in intensity, usually reaching a seven or more on a pain scale.

What Can Make Chronic Pain Flares Worse?

Several things can make a chronic pain flare worse. The following are a few examples:

Stress

Chronic pain can be made worse by things that your brain interprets as threats. Stress is one of those things.

Lack of Sleep

Lack of sleep can make you more sensitive to pain and increase pain. Pain and sleep share similar pathways and neurotransmitters in the brain. Sleep deprivation may interfere with the brain’s ability to inhibit pain.

Certain Thought Patterns

Thought patterns, like catastrophizing, can increase pain by increasing interpretations of threats.

Not Listening to Your Body

When you don’t listen to your body, you can make your pain worse. Your brain may believe you aren’t listening to the signals (pain)  it sends, making those signals louder (higher pain levels).

Certain Emotions

Fear can increase your pain by three times or more. Other emotions that increase pain include anger, shame, guilt, sadness, and anxiety.

Pressure & Intensity

Pressure and intensity are other things your brain interprets as threatening and can increase pain. They also interfere with relaxation coping mechanisms like mindfulness.

What to Avoid When You Are Having a Chronic Pain Flare

Some of the things you may want to avoid during a pain flare include:

• Doing too much or too little
• Catastrophizing
• Overreacting
• Using medication improperly
• Avoid new or frustrating activities.

When you are having a severe pain flare, it is not the time to try out new coping strategies that you haven’t put into practice.

What You Can Do to Decrease Your Suffering

Prevention of Pain Flares and Reducing Their Intensity

Trigger Identification and Awareness

Triggers can be anything that your brain interprets as a threat. 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 or sudden temperature changes
• Changes to sleep quantity or quality
• Family or relationship challenges
• Work or financial challenges
• Changes in mood
• Extended periods in one position or doing one activity
• Recent illnesses, including colds and flu, changes in medication, or getting a vaccine.
• Changes in hormones
• Trauma triggers

Identifying triggers can be beneficial in reducing pain flares or being prepared for them. Try to determine if there is a pattern to your pain flares or increased pain levels. Consider looking at the days or hours before a pain flare and determining what may have caused it.

Identifying some of the warning signs of a pain flare can give you the time to set yourself up and take action to prevent it from reaching the same duration and intensity.

Pacing

Pacing is vital for avoiding pain flares. Ultimately, pacing is about finding the middle ground between inactivity and doing too much. It encourages you to stop an activity before reaching your limit. For some activities, you may break the activity into smaller sections; for others, you may find what amount doesn’t cause you additional pain and slowly build up. You work within a plan to avoid the boom-and-bust patterns and pain flares.

Physical Activity

It’s crucial to find a baseline of physical activity that you can do without experiencing pain increases. From that baseline, you can slowly increase your activity so you can do more.

Listening to Your Body

By listening to your body, you can be alerted when you are reaching your limit so you can stop the activity before paying it as a pain flare. Our limits may change depending on fatigue, recent nutrition and activity, and pain levels. Listening to your body is an art you can further develop over time.

Thought Patterns

Specific thought patterns can increase your pain and stress. When you learn to reframe your thoughts when your pain is settled or close to your baseline, you can manage them better during a pain flare.

Stress

Stress and chronic can feed each other. When one is terrible, it feeds the other. Learning to manage stress levels can help to minimize pain flares.

Perceived Threat

When your brain perceives a threat, it may sound an alarm in the form of a pain flare. These alarms are efforts by your brain to protect you. Often, these alarms are false alarms. If you can retrain your pain to stop perceiving these false alarms as threats, you can reduce your pain flares.

Knowing the Difference Between Hurt versus Harm

You experience a lot of hurt when you are in pain, but that pain doesn’t indicate harm. Harm is often associated with the pain of a new injury or illness, but it is not the same for chronic pain. When you realize that a pain flare is hurtful but not harmful, it can help to deescalate the cascade of associated worries and fears that can increase pain and contribute to pain flares.

Mindfulness and Relaxation

Mindfulness and relaxation can help to calm your nervous system. Additionally, mindfulness can help you to observe and de-identify from your pain. They can help reduce the mental and emotional toll of pain.

Acceptance of Your Pain

Acceptance of your pain is very challenging. It’s about realizing you have a “new normal” and managing your expectations accordingly. Acceptance doesn’t mean you like it; you know it is what it is. Acceptance is a place where you are no longer fighting the pain by pushing through or ignoring it, as those attitudes can result in more pain flares and emotional suffering.

Preparing for Chronic Pain Flares

Creating a Plan for Chronic Pain Flares

It’s essential to have a plan for pain flares so you feel more prepared and ready to cope. Having a plan can lower your anxiety and suffering during a pain flare because you know how you are going to take care of yourself when you have problems thinking due to your pain.

What you may want to consider for your pain flare plan:

• Whether you need medication to help you get through the pain flare. It is something to discuss with your doctor.
• What coping statements will you use during your pain flare and practice before so your anxiety and suffering will be less during a pain flare?
• What you will make sure is available so you can take care of yourself.
• What will you use to comfort yourself during a pain flare?
• What may distract you?
• How will you get some movement so underactivity does not increase pain over time?
• What will you use to care for yourself during a pain flare?
• How will you make sure you drink enough and get enough nutrients so you don’t go backward in your pain journey?

Create a Chronic Pain Flare Kit

A pain flare kit includes things that help you get through a pain flare in an easily accessible way. It can include:

• A checklist of things to try to help with your flare
• A list of your coping statements so you can read them during a pain flare.
• Things that comfort you include photographs, cards, inspiring quotes, favourite books or movies, etc.
• Activities to help distract you, like a colouring book, rubrics cube, puzzle or Lego
• A heat pack is often used to increase blood flow, relax muscles, and relieve pain localized in the joints.
• A cold pack – often used for reducing blood flow, reducing swelling, and disrupting pain signals
• Essential oils
• Relaxation and mindfulness activities

During a Chronic Pain Flare

Recognize what is happening and how you are feeling. Allowing yourself to feel how you feel – without judgement or guilt – can break the cycle. 

Medications

Take the medications your doctor prescribes, but avoid escalating doses for prolonged periods. Using your breakthrough medication, as prescribed by your doctor, can help reduce pain in the short term, but implementing active self-management strategies should be considered to avoid the long-term need for escalating medication doses.

Kindness and Self-Compassion

When you show kindness and self-compassion towards yourself, you can find ways to care for yourself. It may mean treating yourself like you would a friend or loved one. You may watch your favourite movie, listen to music you enjoy, sit outside, or take a bubble bath.

Distraction

Distracting yourself from the pain can help you gain distance from the pain. Some distraction activities include hobbies, puzzles, colouring, games, etc.

Acceptance and Relaxation

Acceptance is about taking the world as it is. When you are fighting the pain, you can add tension and interpretations of threats that can increase your pain levels. Acceptance lowers the threat levels by reducing it to the sensation of pain.

Pain can often be increased by tension in your body. When you relax, it can counteract the tension of the pain.

Managing Thoughts and Emotions

Your thoughts can increase your pain. They have the potential to add fuel to the fire of your pain. You can reduce this effect by reframing unhelpful thoughts and escalating worrisome thoughts.

Finding a way to express, vent, and release painful emotions can improve your pain. You can do this through expressive writing, talking to a friend or therapist, and other strategies.

Keep Moving

When you are in severe pain, you may want to curl up and hide. It is vital to keep moving. It doesn’t have to be intense. Try to achieve at least 30 minutes of movement per day. It doesn’t have to be at one time. It could be for 5 minutes at a time, doing daily living activities such as putting away dishes. Respect the limitations of your pain without being so inactive that your pain gets worse long-term.

After a Chronic Pain Flare

You are strong in your resilience. There is strength in your determination to keep going. Recognize your strength, perseverance and resilience in managing your pain. It is exhausting doing all you do to cope with your pain. After a pain flare has passed, take the time to take care of yourself. You have been through a battle and survived, but there are wounds to care for.

After a pain flare, take the time to note what worked and what didn’t work. Use what worked in the future and find other strategies to try instead of what didn’t work.

Speak with your healthcare team to help you manage your flares. Remember, you are not in this on your own. 

Conclusion

Chronic Pain Flares can be difficult and distressing to deal with. Fortunately, there are ways to reduce them and reduce their intensity. There is hope for