Here are some suggestions on managing pain flares.
What can you do when your pain flares up? Try Liz Macleod’s simple strategies to help you cope
Even if you become expert at planning activities and improving your posture according to baselines, there will still be occasions when you have flare-ups. Situations may arise when you have to respond without being able to plan effectively and you may overdo things. One morning you may wake up after lying in an awkward position and find your pain has flared up.
Accepting the problem
Patients on the pain management programme have said that, prior to attending the course, their only way of dealing with a flare-up was to give up on activities, rest, take more medication and wait until the pain settled down again. As many of you will recognise, this can leave you frustrated, fed up and feeling that you have little or no control. You may also find that the next time you try the activity the pain returns, but more quickly.
So what else can you do? The first thing to realise is that flare-up is part of a chronic pain problem and will happen, so trying to accept this can be useful in itself. If you can view the flare-up as a real nuisance but not something to worry about you are less likely to become as agitated and annoyed. You will also be more able to work at managing the situation.
Know your triggers
Try to think about what may have triggered the flare-up. If there is a clear pattern, it’s easier to avoid the same set of circumstances in the future. If you don’t avoid the trigger, then you can expect another flare-up. Sometimes it is difficult to associate an activity with pain when the flare-up occurs the day after you have carried out the activity or maybe even the day following that. If you have difficulty identifying the cause of flare-up, try keeping a diary of your activities and at the same time a score of your pain. You can then look back over your week and see if a pattern arises.
We had one patient in our programme who noted that an increase in her pain occurred two days after her baby grandchild came to stay for the morning. She then began to notice that she sat in an awkward posture when she was feeding the baby. She rearranged the seating position, shared feeding with granddad and the flare-up of pain after babysitting no longer appeared! If there is no apparent trigger it will be difficult to know what to avoid; you will have no warning, so it is essential to have a clear plan for coping.
How to manage a flare up
Soothe the pain
Note the things you can do that make your pain easier. Maybe a heat pad or warm bath. What about a visit to your local Jacuzzi? You may be surprised by how effective a Jacuzzi can be in helping you relax. The whirling water soothes tired, painful muscles which feel in spasm or are guarding the pain. If massage helps you then this is the time to use that option. Sometimes lying down for a little while can help. Lying for longer periods can result in feelings of stiffness, so short periods, often, are more likely to lead to success.
Relax
Have you learned any relaxation techniques? Your muscles hold you tightly and guard more when you have increased pain, so learning how to let go and ease the tension can be really helpful. Relaxation can help you feel calmer and more at ease with the situation. You can listen online (www.paincd.org.uk), borrow a CD from your local library or there may be relaxation classes nearby.
Distraction
Being able to take your focus away from the pain and think about something else can be helpful. Examples are counting how many doors in your street are painted black, or trying to make a word from car registration letters. Imagine a situation where you felt peaceful, in control, and happy. Use the image to help you remember how that felt and how enjoyable it was for you.
Cut back on activities
In flare-up it’s a good idea to cut back slightly on your activities, but not to give them up altogether. There is a risk that you will lose fitness for these activities if you stop them. After all, the flare-up may last a week or two, which is plenty of time for your muscles to lose tone and your cardio-vascular system to become a bit sluggish. To cut back you may need to ask for a bit of help from family, friends or work colleagues. As the flare-up begins to settle, you will be able to get back gradually to your usual levels of activity.
Catch negative thoughts
Feeling fed up and frustrated with your situation is normal in times of flare-up. It is at this time though that unhelpful thoughts creep in which lead to anxiety or low mood. Try and be aware of these and nip them in the bud! Remember the flare-up will settle and you will get through it.
Medication
Hopefully, if you have had success with the above strategies, you will not need to take extra painkillers during flare-up. If, however, you feel extra medication could help you at such times, you should talk with your doctor or pharmacist. They may be able to help with planning the dose you could take and to advise how long you are likely to need your medicine before cutting back.
People who tackle flare-up in this way will have worked out a mini plan for a flare-up lasting a day or two, and a plan for a longer period of flare up. They know how and when to cut back. A flare-up is no fun, but if you can plan for it and feel more in control, it may be easier to manage and less stressful.